C10000074 / invoice 20000

Presented for a recheck
Owner reported Daisy's back pain originally improved, however she is still shaking, lethargic and not herself (however she is on gabapentin, which may be contributing to the sedation)
no vomiting besides the one off episode after the visit at WAVES
she is still eating, but she is fussy (pretty normal for her)
her stools are solid however she has been passing mucous with blood after defecation 
currently on gabapentin PO and paracetamol 10 mg/kg PO BID 
o reported no ataxia or paresis at home 
currently feeding chicken and rice, dog kibble and dog wet food, some cheese, some cream and yogurt to give her medication

PE
BAR, tried to bite myself and owner several times. was muzzled for exam 
unable to lift lips, could not examine gums
HR 120 bpm with no murmur
RR 36 bpm (stressed)
abdomen tense but nonpainful 
no flinching/discomfort on back palpation
hind limb proprioception and withdrawals intact 
T 39.1C
no LN enlargement 


Discussed blood and mucous likely caused by colitis (stress and pain, or due to frequent table scraps fed to give her medication, or due to continued underlying systemic inflammation)
Starnge case as such severe back pain is not common in young dogs, especially when there is no known hx of trauma 


Offered to repeat bloodwork today, o consented

Ran GHP + CRP in house
low retic:hb
plt 96 L (however there was a clot in the tube, no obvious clotting seen on cytology)
CRP 84.3 H (was 74 at WAVES) 


discussed mild increase in CRP, which is not necessarily correlated to a marked worsening and may be just caused by concurrent colitis 

Recommended to monitor, increase panadol to TID dose and keep her to a strictly bland diet (chicken and rice). If she does not take medication, favor low fat unflavored yogurt. 
dispensed prokolin to decrease inflammation in the colon 

consider Xrays or referral if not improving by monday 

Reason:  O called to cvanecl appt

Nurse: yfw
History: 
O has called to cancel appt this afternoon as is doing much better. and seems relatively comfortable. Able to get herself up and around and to the toilet. She will not let Os sling her or help her up and will try to bite which is normal for her. O has only been able to get a little bit of food into her but she is also normally a fussy eater. Has been able to give one dose of paracetamol so far with some yoghurt and is giving gabapentin BID.  Urinating fine. Did look like she was straining a little to defaecate but O said she passed a small amount then looked like she might have been trying to pass some more.
Re assessment appt made for 4d time +/- repeat CRP bloods as per WAVES recommendation

Have advised O that if refusing food or continuing to strain to toilet or appear in discomfort again then should be seen sooner

O called to update 
O stressed pet seems to not want to walk and is generally worried about pet
Did explain that pet is ideally resting and would not be out of the ordinary for her to be subdue after potential dx and opioid injection.

Offered o appointment this afternoon to reassess and give medications (Gabapentin and paracetamol)
O has declined at this time as she was more worried about the fact Daisy seems disinterested in moving.

No vocalisation
Can move to sitting 
Hind legs have moved when sleeping.

Overall assured owner that resting is the best for now
HAve book RV tomorrow.
O may call to move to AM if still worried- Natasha U