C09989895 / invoice 10000

7.55am Found passed away in the cage, bloody discharge in the cage, little tray and floor. WH phoned Bronwyn informed the death, O declined autopsy, O upset but understanding. Offers and agreed to put in body bag and O to contact for time to come to the clinic as O has whole day work. O to decide on aftercare. Will sort out the insurance.     Vital Signs    

Appointment Notes: Nurse admit- O has to start work at 9am. Oreo has been V+ last few days, now has suspected blood in it. Won't eat now at all even though he is typically very food motivated. SW Has previously had hair-ball foreign body ingestion, with surgery at AES mid-jejunal. Vomiting past 2 days, watery, pinkish colour this morning.Haven't tried much to decrease hair load at home. Last night - vomited a bit straight after eating, then went to sleep. Vomit everywhere this morning. Less faeces in litter tray then usual last few days. Diet: Dry food, Royal canin home lyfe. Normally vomits every day, tried z/d got better, since going on RC home lyfe has decreased even more. Also FIC cat. Try to drink last night, everything keeps coming back Lethargic, hiding, sleepy Just indoor cat, due for preventives now Examination: T: 39.1 mm: pink & tacky, crt <2s HR: 200bpm, no murmur, normal rhythm RR: 48bpm, clear lung soundsAbdomen: 2 palpable firm structures mid abdomen, soft-ish. minimal pain response (before sedation) to deep abdominal palpation, bladder small. No other abnormalities on examination. MSK: NAD Diagnostics - Okayed x-rays & full bloods - Had to gas down for bloods + catheter as aggressive, once anaesthetised, 0.2mg/kg methadone IV. Adequate sedation achieved. Bloods collected, x-rays performed. X-rays: LLAT, RLAT, VD. Faeces in colon, mostly empty looking SI, slightly bunched, mild dilation transverse colon proximal to faecal matter, normal gastric axis. Good serosal detail, kidneys, liver, spleen WNL, bladder WNL. Bloods - - RBC WNL higher end but no haemoconcentration. - neutrophilia, bands? check smear (okay)- Biochem - SDMA increased, glucose increased (stress), lytes WNL, amylase/cholesterol increased (2ndry to azotaemia likely).DDX: - Impaction poss. obstruction- Inflammatory leukogram - Dehydrated/mild azotaemiaDiscussed with Os medical management vs. surgical - opting medical at this stage, cost a lot of $$ previously a bit constraint, but insured (unsure maxed out, O concerned). Treatment - medical (fluids, laxatives, enema), monitor with repeat x-rays serially, if no improvement by tomorrow or no movement on impaction --> surgery. Discussed previous surgery, increased risks for surgery, potentially more-so post-op this time. Discussed hair-ball management shaving/dietary control, osmolax regularly. Lunch: Much unchanged TPR WNL. No pain abdominal palpationPM: TPR WNL, no pain abdominal palpation. No V+ ate recovery and wet mousse. No D+ or U+Fractious, alfaxan IV for x-rays (0.5mL), rectal faeces feel much the same position wise (at end of index finger). Rads - minimal change, slight increase dilation proximally. Gastric dilation - medications, impaction/ obstruction, aerophagia? Microlax enema given. Keep in hospital overnight on fluids - re-xray in AM, possible ex-lap.     Vital Signs