C09994858 / invoice 20000

Lisa spoke to Leanne- once had gaba yesterday was vmi, much more comfortable and seemed his normal self. Has a good night. Has not given gaba since No vomitingPassed a normal BM this morning, no straining. Since ate something this morning O thinks he seems a bit sore again, not as bad as yesterday but unsettled and stretching HLs out. Gave more gaba and is a lot more comfortable again.Laboratory: CBC wnlBiochem incl lipase and amylase wnlAwaiting spec cPLDiscussed abdo u/sound as next diagnostic step. O considering. In the meantime start food trial- Hills z/d or RC anallergenic exclusively If needing more gaba over the next couple of days rec abdo u/sound sooner rather than later    Vital Signs    

History:Presents for vomiting over the last couple of weeks. The vomiting began after ingesting bamboo. Initially, there was severe licking and hypersalivation. The owner administered milk and an anti-pruritic tablet. An initial large vomit occurred, followed by intermittent vomiting of yellow bile every few days since. On one day, there were three episodes of vomiting. The vomiting typically occurs in the morning, not directly related to food intake. This morning, there were signs of abdominal discomfort, including stretching in a 'praying' position. Otherwise, the patient is reported to be bright and happy. Stools are normal with no mucus reported. Appetite is normal.History of seasonal pruritus, which is generally well-managed with Apoquel. Usual diet is a grain-free kibble and home cooked roo and veges. There has been a lapse in worming treatment for approximately four months but previously on NG spectra Examination:Bright, alert, and responsive. Chest NAD, HR/RR wnl, eyes/ears NAD. PLNs NAD. Abdo soft and NAD. Normothermic. Integument NADGums pink and moist CRT<2secs. Assessment:The presenting signs of intermittent vomiting and abdominal discomfort (stretching) are suspicious for pancreatitis, possibly triggered by the initial gastrointestinal upset from bamboo ingestion. A food allergy is also a differential, given the history of pruritus and gastrointestinal signs.Other ddx: partial FB, neoplasia, IBD, extra-GIT causes eg hypoA, cholangitisPlan:Blood tests will be performed to investigate for pancreatitis and rule out other systemic causes. Results are expected tomorrow.Pending blood results, the diet will be changed to a bland, low-fat intestinal support food.If blood tests are normal but symptoms persist, a food trial with a hypoallergenic diet will be considered.If dietary changes are not effective, an abdominal ultrasound will be recommended to further investigate the pancreas and gastrointestinal tract. Estimated cost for an ultrasound is approximately $800.Discussed restarting monthly worming treatment with NexGard Spectra immediately.Dispensed 30 anti-pruritic tablets (Apoquel). The owner was advised to give half a tablet twice daily for up to two weeks if needed for flare-ups, then reduce to once daily for maintenance. However, it was advised to withhold this medication for now while the patient is nauseous, as it can exacerbate gastrointestinal upset. Advised to use medicated shampoo and paw soaks for pruritus in the interim.Client communication:Discussed the possible link between the bamboo ingestion and the current signs, with pancreatitis being a primary differential diagnosis. The potential for food allergies causing both dermatological and gastrointestinal signs was also explained. The plan for diagnostics, including blood tests and a potential ultrasound, was outlined, along with associated costs. The importance of consistent, monthly parasite prevention was reinforced. Instructions for the use of anti-pruritic medication were provided, with the specific recommendation to avoid it during the current period of nausea. The owner understands the plan and will proceed with the blood test.--- 04/03/2026 12:41:50 CL7:12.30 pm: Couple of hours after visit Leanne called to say Pluto looks more uncomfortable since visit- pacing, stretching HLs out behind him, can't settle. Straining to poo, then did a normal looking BM. Ate this morning and did not vomit.Options: 1. go straight to VSOS for abdo u/sound2. Pain relief whilst awaiting blood results from idexx3. Draw more blood for CBC/biochem in house to get some results immediately, will not include specCPLO wil collect gaba to give asap- if not improved within the next couple of hours take straight to VSOS for abdo u/sound    Vital Signs    Weight: 16.3;