C09995764 / invoice 10000

Did okay for a few days
retching again last night though and was more needy 
Gave a chicken neck yesterday
Otherwise completely normal

CE:
- BAR
- eyes bright and clear
- mm pink and moist, CRT < 2 seconds
- HR 110
- temp 37.5
- abdo palp relaxed and comfortable, maybe slightly more tense on cranial abdomen 


add in omeprazole SID 10mg x 5 days
feed little and often
hold off on chicken necks

Hi Sara,

Sorry about that, these reminder texts come through 2-3 weeks early to prepare you time-wise for her, so no stress about not having the wormer today. It is due on the 14th of March.

If you like, I can leave it on the side of reception for next time you're in the area?

Let me know what you'd like to do :)
Tayla
RBVH

History:
- Bright yellow vomit noted Friday/Saturday, likely overnight
- Owner heard vomiting noise during the night
- Vomited liver treats given before bed
- No history of foreign body ingestion, not an indiscriminate eater
- Bright, happy, good appetite
- Normal energy levels, trotting around, excited for food

Physical Exam Findings:
- BAR, Crt1s, Mms pink, HR120, T 38
- abdo palp normal
- ears, eyes, nose, mouth, skin, LNs all ok

Diagnostic Results:
- Recent comprehensive blood work within last week - everything else normal
- mild elevation of liver enzyme noted, has been up before and come down before

Assessment:
- Problem list:
1. Vomiting - likely bile, secondary to liver treats
2. Mild liver enzyme elevation - stable, not concerning

Plan:
- Bland diet for 2-3 days: boiled chicken breast, white rice, small meals throughout the day
- No table food, no biscuits, no treats, no bones
- Small meal before bed to prevent bilious vomiting syndrome
- Chicken treats acceptable once back on normal diet
- Review if still vomiting by Wednesday - recc abdo Imaging 

Communications:
- Discussed likely cause of vomiting is bile from liver treats
- Reassured owner that mild liver enzyme elevation is not uncommon and does not indicate illness
- Advised to discard old liver treats
- No charge for today's visit