C09993184 / invoice 10000

Reason: CoughingVerified: NoHISTORYPresenting for: Moochi, a 9-year-old Pomeranian, presented for acute onset respiratory distress characterised by episodes resembling talking motions without vocalisation, occurring since this morning after breakfast.Historical Conditions:- TPO surgery performed exactly 3 weeks ago- No previous history of coughing or breathing issues- Other dog in household has allergies and pruritusDiet:- Normal appetite maintained- Bones in morning, vegetables and wet food- Ate normally today including dinnerV/D/C/S:- Episodes described as silent talking motions, not gagging or gasping- Duration of individual episodes lasting several minutes- Frequency increased throughout the day, particularly when excited- Intensifies when family members return home- Completely stops when in car- Different from reverse sneezing episodes seen in household's other dogCurrent Meds:- Meloxicam (due to stop tomorrow)- Gabapentin in morning- Antibiotics recently completedLifestyle Risk Factors:- Lives with another dog- No recent changes to household environment, cleaning products, plants, or visitorsOther:- Episodes noticed by owner's mother after lunch, intensifying when family returned home- Patient shows excitement when owners return home- No exposure to new chemicals, aerosols, or diffusersEXAMMentation: BART: NormalMM: Nice and pinkBehavioural: Anxious during examination, panting due to stress, stops exhibiting respiratory episodes completely when in car and during consultationThroat: No sensitivity on tracheal palpation, unable to induce cough through tracheal manipulationCardiovascular: Heart sounds normalRespiratory: Chest sounds clear and normal, no evidence of fluid or obstructionOral: Normal structures visible, food pipe not visualised beyond base of tongueASSESSMENTSuspected collapsing trachea - Episodes consistent with tracheal collapse given breed predisposition, age, and pattern of occurrence during excitement. Honking sound typically associated with condition not observed, but silent presentation possible. Obstruction considered unlikely given intermittent nature and complete resolution in car.PLANDiagnostics:- Chest radiographs recommended if episodes continue or worsen (requires sedation)- Client advised to attempt video recording of episodes for further assessmentAdditional Discussion:- Explained collapsing trachea as age-related change common in breed- Medical management options available including bronchodilators, but surgical correction carries significant risks and only recommended for severe cases requiring specialist referral- Obstruction unlikely given intermittent symptoms and normal appetite- Allergic causes possible but less likely given no environmental changes and late age of onsetClient Comms:- Monitor for increased frequency or severity of episodes- Seek emergency care if patient adopts orthopnoeic position (chest and neck extended forward) or shows constant panting/distress- Return for radiographs if condition persists beyond today- Look up online videos of Pomeranian tracheal collapse for comparison with patient's symptoms    Vital Signs    Weight: 8.4;