C09994790 / invoice 10000

Reason: SASH Client For Rehab And Mr Barker Record AttacheAppointment Notes: IVDD and stomach issues vjrHistory: Seen by physio at SASH - monthly - going really well with IVDD/spine - recommended to come here for acupunctureFaecal PCR normal - apart from positive clostridiumReally unsettled lately - 'gulping' - see at sash aug 25 for itDemands food at night - seems to help her settle but has caused her to gain weight. Increased thirst, panting more, At night doesn't look as comfortable - O attributes to having a sore belly possible?No vomiting regularly - did vomit once a couple of weeks ago - after she had eaten extra - came stragith back up. Tendancy to constipation if anything. Lyka - currently on kangaroo - last 4 years - last 2 years have added mashed pumpkin to diet to help with stool consistency. Have also used NOSH digetsive but thinks that rice may have made her worse. Has had abdo ultrasounds at Mt Barker with Xander/another vet from Austin - not worried about minor nodules. Blood testing - couple of months ago - all normal - o thinks it included thyroid and B12O sister is a vet - has suggested considering metaclopramide and/or peptosyl as an option to trial - has tried yetFood trial NOT done as this stageAppetite is fine, wants more if anything Current Medications:Antnol dailyOndansatron - intermittnetly - O doesn't feel does anythingLosec trial - had 2 x 10mg tablet bid - then had really bad diarrhoea - very runny with blood - hasn't trialled again since then. Canine ceuticals gut restore - small dose currently - adding slowlyTongue - pink, thin, poss slight purplish tinge Nose - paler, was dark originally, on top of nose lost hair a couple of years ago then all came backPulse - wiry, deep, hard to compressEars - warmFeet - cool Senior: discuss if needed.Vaccinations up to date ? Examine: Diet: Dental/oral cavity: Eyes: Ears: Cardiovascular/respiratory: GIT/abdomen: Urogenital: M/skeletal: Skin: Lumps: Lymph Nodes: Behaviour: Assessment: Treatment: Metoclopramide for management of vomiting disorders, gastroesophageal reflux, delayed gastric emptying, ileus, intestinal pseudo-obstruction55.6 lb/25.2 kg dogsGIVE 5.04 - 12.6 mg IV, PO q 8 hoursPlan: Script status:  Checked and updated? Yes/NoVaccination / Blood test / Catrophen Reminders up to date? ADJUST ACCORDINGLYRevist/ Recall/ Reminder:Prescription Form6 March 2026Owner	                      Ms K Dornin                      10 Wagtail Way                      Mount Barker SA 5251Patient		TulleySex		Female Details		Cream Golden Retriever Weight              25.2 kgMedication	  Metaclopramide 10mg Quantity:	100 tablets Instructions:	Give ½ to 1 tablet every 8 hours as required for reflux. Repeats:	2___________________    6/03/26Clare EllisWillunga Veterinary ServicesSA Veterinary Registration Number 1604Verified: NoHistory:Presenting for: Tulley, an 11-year-old female spayed Golden Retriever, presented for gastrointestinal issues including reflux and gulping behaviour that has worsened significantly over the last 6 months, with episodes now occurring consistently rather than intermittently.Historical Conditions:- IVDD diagnosed at SASH with CT and MRI- Receives physiotherapy every 4 weeks at SASH with good response- Previous lumps removed around eyes (all benign on histopathology)- Recent faecal PCR normal except for one bacteria (Clostridium species) - not considered significant- Blood test a couple of months ago was normal, believed to include thyroid and B12- Ultrasounds at Mount Barker (end of last year) - few small nodules found but not considered concerning- Episode of severe diarrhoea with blood after Losec trial (20mg twice daily for one day)- Nose pigment loss a couple of years ago with no underlying cause identifiedDiet:- Currently fed kangaroo diet for last 4 years with mashed pumpkin added for last 1-2 years due to constipation- Recently tried chicken and rice but seemed to worsen symptoms- Now feeding chicken and pumpkin- Appetite excellent - actually demanding more food, especially at night, which owner believes helps settle the symptoms- Has gained significant weight recently due to increased feedingDrinking/Urination:- Increased thirst noted, uncertain if related to panting or primary polydipsiaV/D/C/S:- Primary complaint is gulping behaviour described as exaggerated swallowing, suggestive of reflux- One episode of vomiting a couple of weeks ago (unusual for this patient)- Historically had occasional gulping episodes as a puppy, would go outside to eat grass then settle- No regular diarrhoea, usually normal stools- Slightly more constipated with age, improved with pumpkin additionSkin:- Coat has become very fluffy recently- Significant halitosis notedCurrent Meds:- Antinol daily- Intermittent Dentastix (ineffective for breath)- Small amounts of Sootical's Gut Restore (not full dose, introduced slowly)Lifestyle Risk Factors:- Lives with another Golden Retriever- Previously very active and playful until 6 months agoOther:- Symptoms significantly worse at night - becomes unsettled, panting, increased thirst, appears uncomfortable when lying down- Episodes previously occurred every 3-4 weeks but now consistently bad for last couple of weeks- Still mentally alert with good vision and hearing- Owner's sister is a veterinarian who has exhausted recommendations- Decreased activity level and no longer playing with other dogExamination:Mentation: BARBehavioural: Very well-behaved during examination, readily accepted treats, comfortable with handling and acupuncture needlesOral: Gums good, teeth pretty good considering ageIntegumentary: Very fluffy coat, one small lump near eye being monitored (stable size)Cardiovascular: Pulse described as forceful, strong, deep, hard to compress - characteristic wiry pulse indicating stagnation in Chinese medicine termsOral: Tongue relatively thin, slightly too pink-purple in colour, has small dimples on sides where teeth rub - overall healthier appearing than typical Golden Retriever tongueAssessment:Gastroesophageal reflux with chronic gastrointestinal signs - From Chinese medicine perspective, patient presents with signs of stagnation affecting the triple burner (middle abdominal energy flow), evidenced by wiry pulse and tongue characteristics. Pattern suggests disruption of natural energy flow through the body, particularly affecting stomach and liver meridians.Plan:New Meds/Tx:- Metoclopramide (Maxolon) prescribed - 1/2 to 1 whole tablet, can be given every 8 hours but recommend starting with once daily in evening. Acts to tighten oesophageal sphincter to reduce reflux- Omeprazole (Peptosyl) available if owner wishes to trial, though limited evidence for efficacy in canine reflux- Acupuncture treatment performed today using points ST36 (stomach 36), Large Intestine 10, and back points to address stagnation and improve gastrointestinal function- Plan for 3-4 acupuncture sessions (veterinarian away for 2 weeks after next week)Additional Discussion:- Chinese herbal formula Chai Hu Shu Gan Tang being considered for harmonising the middle - veterinarian to review patient history and assess suitability before dispensing- Herbs typically require 3 weeks to show effect- Food trial with novel protein (Prime 100 crocodile roll with tapioca) discussed as next step if current treatments ineffective - expect response within 1-2 weeks for gastrointestinal cases- Endoscopy remains an option but owner prefers to avoid anaesthesia at this time- Lymphoma blood test (new Idexx test) mentioned as possibilityClient Comms:- Owner to trial Maxolon first, then Peptosyl if needed- Return next week for second acupuncture treatment and herbal assessment- Consider food trial if no improvement with current approach- Monitor for treatment response - some dogs respond within 24-48 hours, others show gradual improvement over time    Vital Signs    

Sash History attached to file - x4Full history from Mount Barker Vet attached to file.CT / MRI at SASH Dec 2024CONCLUSION1. Compatible with slight generalised intervertebral disc degeneration.2. Annular bulging of the intervertebral disc at T13/L1, with marginal spinal cord compression.3. Slight intervertebral disc degeneration L6/7, L7/S1, with no spinal cord or cauda equina compression.    Vital Signs