C09998770 / invoice 10000

***INITIAL CONSULT****
Date/Time: 09/10/18 1500hrs 
Clinician: Tim Conolly
Taxue has a reduced appetite and has been passing softer stools progressing to d+ overnight. The d+ has some solid components to it and is now slightly blood tinged. She is also lethargic. 

Diet: normally Taxue gets Hills Science diet, +/- dog roll or ham. Prior to the onset of signs, Taxue was fed another dog's wet food that is different to her regular diet. 

No previous health concerns but Taxue's gut has been prone to being sensitive previously 
No current medications 
Vaccinations and worming UTD 
There is another dog in the household, the other dog is healthy
Taxue is mostly indoors but has been allowed into the back yard, but has not been to the park / out of the property 

PHYSICAL EXAM:
Taxue was very anxious to examine
Temp: 38.9C 
CardioV: HR: 120 (anxious) Rhythm: normal Sounds: normal CRT: <2sec MM: p+m 
Resp: RR: pant  Effort:normal Sounds: clear 
Neuro: BAR 
GIT: uncomfortable- difficult to assess as very nervous and tense 
Urogential: NSF 
Musculoskel: NSF 
Mouth: NSF 
Eyes: NSF 
Ears: NSF 
Integument: NSF 
Abdopalp: NSF 

PROBLEM LIST + DDX LIST:
abdo pain? 
reduced appetite 
blood tinged diarrhoea 
DDX: gastroenteritis- detiary most likely  , pancreatitis, 

CLIENT COMMUNICATIONS/TX/PLAN:
Discussed case and recommended treatment trial at home , explained that whilst Taxue was sick, she did not warrant immediate admission to hospital given that she was still eating (appetite reduced) and that she was otherwise stable. Explained that I felt that Taxue would benefit from a home medicated trial given how anxious she was., 
- administered maropitant 1mg/kg and buprenorphine 0.01mg/kg SC . 
- dispensed 10 day course of metro 400mg PO Q12 
- recommended bland diet of chicken and rice for 3 days and gradual re-intro of regular diet ,