C09993244 / invoice 10000

See attached waves hx, ongoing chronic airway disease, facial twitching has been previously noted.  Has B1 mitral valve disease.
Suspect todays episode related to previous ongoing health issues, unlikely heart and more likely respiratory or neurological.  Although walked early today was a warm day.
Discussed with O, keep quiet today and continue with consult at waves, will send through history.  May need reassessment of respiratory disease/facial twitching.
O happy with this.
Called WAVES just to let them know.

Reason:  Breathing concerns
History:  O reports this morning went on his walk and was slower than normal, got home and just lay down, then on his side (face seemed to be twitching but no paddling), then panting more than normal afterwards and brought straight down.  Had a slightly similar but much more severe episode a few years ago and was seen at MUVH (but O wasn't particularly happy with them at the time).
Previously recently had TECABO bilaterally at WAVES, and had cardiac workup with Rita.  Also has history of chronic cough which has been slightly worse over the last few days.  Regular vet is Morley vet centre.

Current medications: Pimobendan 2.5mg bid PO

Examine: 
Mentation: BAR
Body condition score: 4/5
MM:   pink and moist             CRT: <2s
HR:  130              RR: pant
LN: nad
Temperature: 38.6

Ocular: nad
Oral/Dental stage:1
Ears: both ears have had TECAs
Cardiovascular: 3-4/6 murmur
Respiratory: normal effort, panting, normal lung sounds,
Gastrointestinal: nad
Integumentary & lumps (measurement, location):nfe
Musculoskeletal: stiff gait, no lameness, sits with hindlegs out to the side, mild decreased rom in hindlegs
Urogenital: nad
Neurological:  head tilt to the right, possibly mild ataxia in consult

Problem List:
Assessment: 
Episode of collapse/facial twitching: heart, respiratory, neurological, other: stable patient on exam

Treatment: 

Plan: 
Stable during consult and while awaiting hx, only managed to get Morley hx by end of consult.
Discussed next step bloods/chest rads but given complicated hx may be better to have workup with specialists, stable at time of consult
Has appointment with Meng at WAVES tomorrow, 
Will chase up hx, O to measure SRR and monitor today, and will call O later today and discuss with WAVES

Followup: 

Reason: nail clip
Consult Nurse: mw
History: 
     EDUF: normal, overweight
     Nutrition: overweight, o aware, discussed a plan for toffee's weight loss, o on board and going to bring in for regular weigh ins to keep motivated
     V#/D#/Coughing? no

Examine:
     General Appearance: BAR
     Body Score: 4/5
     Coat/Skin: nad
     Ears/Eyes: nad

Microchip: on file

Assessment: discussed weight and weight loss plan, back nails trimmed but not front as getting stressed, all paws shaved