C09991558 / invoice 10000

Reason: Persistant GastroAppointment Notes: Saw Golden Grove Vet on Sunday but still unwell, doesnt want to go back there in case needs to stay overnight,I did say that if Oscar needs to be hosipitalised we may need to refer to a 24 hour clinic anyway, o understands this. Chasing histories.Might be an interesting one. Missed an appt at Nairne Vet at 10am this morning who then offered them 6pm (owners didn't say anything about the missed appt when he called), they then called us and booked in with us, when I rang Nairne Vet they were still under the impression they were coming at 6pm to their clinic. mbHistory of RH stifle pain/injury?2 weeks ago started with D+ with blood, saw Golden Grove emergency clinic and dispensed Metronidazole, has finished thisStill drinking well, urinating fine at home, however not eating, lethargic, will eat treats stillD+ has improved a lot, dog not eating much however so O a bit unsure about bowel motions nowHas been a "vomiter all his life" ; over last 6 months however has V twice; Did vomit yesterday, but this was a single vomit that contained bile + treatsQuery panting at home?UTD with vacc according to ONo ongoing medsOn Advocate monthlyHad recent Pentosan courseAllergic to steroids (went "loopy" with this?)Examination:QAR, sitting down but relatively bright when roused, interested in treats (didnt feed due to persistent GIT upset)Mm pink and moist, CRT < 2 secNo oral lesionsQuery very very mild icteric tinge sclera? Could just be contrast of white dog fur against sclera howeverHR regular no murmur WNL, respiratory rate and effort WNL, chest clearAbdominal palpation soft and comfortable, no masses/dilation/free fluid felt, dog did burp initially on abdo palpationRectal temp 39.5Somewhat dilated rectum with yellow loose faeces, dog reactive to rectal exam so didnt persist, no blood seenLN NADAssessment:Problem list: 2 week history of D+, reduced appetite, single V, lethargyMaybe initially responded to metronidazole, O unsureDdx: primary GIT disease (inflammatory/infectious/neoplasia/partial FB?) vs pancreatitis vs other underlying organ dysfunction/neoplasia vs toxin vs otherPlan:Bloods to idexx for TAHP; discuss pyrexia but want blood results before more Tx trials for this patientHome with i/d foodDiscuss next steps include potential medications as indicated by blood results +/- IVFT if hyporexia/V continuing, briefly mentioned further diagnostics being abdominal US (referral)History:    Vital Signs