C09991025 / invoice 10000

O reports that cherish hasnt been eating for the last 24 hours, O has fed some chicken but nothing else. No vomiting or diarrhoea.Has just started fluoxetine 1/4 tablet ONCE daily and suspects cherish doesn't like being tabletedHas had previous workup with ultrasound and bloods done recently as had a elevated temperature but no cause was found Clinical- QAR, BCS 5/9- Eyes, ears, nose NAD- Mouth: CRT <2 MMPM, dental score 1/4- Thoracic aus NAD, normal rate and rhythm lungs clear- Abdominal palpation NAD- REctal: temp 38.4Assessment and plan: Concern over tablet causing anxiety preventing dog eating, plan to switch over to liquid fluoxetine ongoing. discussed further workup including bloods, given normal PE today  plan to try an encourage to eat at home for next 24-48 hours and if still not improving then will consider further workup at this point 

In with Yi AnHx:- BIOP for 6 months and since then has been a very nervous and anxious dog. Has been on anti-anxiety meds in the past; Has been on Clomav for a week (roughly 6-8 weeks ago) but O had to stop it because she was a bit flat and sedated. - Had recent episodes of PUO-> been to Strathmore Vet and LSAH however nothing was found on the tests ( more hx on file). - Doing well, no concerns otherwise- EDDU normal- No V+, D+, coughing, sneezing- No ongoing meds currentlyPE:BAR, bit anxious but nice dogBCS: 5/9EENM: NADMM pink, CRT 1.5 sec Dentition: DDGR 1/4 CVS: NAD. No obvious murmurs or arrhythmias. Femoral pulses normodynamic and synchronous. Resp: NAD. No abnormal bronchovesicular soundsAbdo palp: No pain palpatedAssessment:AnxietyDDGR 1/4 Rx:- Fluoxetine 20mg tablets (1/4 tablet SID ongoing)- Gabapentin 100mg capsules (1/2-1 capsule 1-2 hoursb efore stressful event) Plan:- Had a discussion about anti-anxiety meds in dogs and how it works. O aware it may take 6-8 weeks before any effect is seen and it is common to have mild drowsiness/ sedation as a side effect, which is most notable at the start of the med course. O happy to trial on fluoxetine and gabapentin PRN. Will review and reassess in 6-8 week's time. 

Sandra has been talking to the O.O wish to book a CT scan ASAP with us otherwise she can be seen by Lort Smith on Thursday this weekWe have informed the O that we can only refer Cherish to do the CT scan much later than LS and then O choice to stay with Lort Smith