C10000474 / invoice 10000

 Have reminders been checked? YHas the owner been advised of this? n/aHX:Reminders checked: YO very concerned, started coughing again last Sunday (cough had completely resolved with actacode)No better since starting doxycycline. O unsure if these are being kept down, given Billie is bringing up alot of frothy material.Is not herself - less inclined to sit on the couch with them/less activeIs still eating - o has been feeding small amts of food oftenNo regurg/vomiting undigested foodDoesn't tend to eat sticks/foreign objects, not offered bonesUTD with NGSExam:OMMs pink CRT 1 sechacking cough elicited on tracheal palpation/pinchno obvious abns identified in oral cavity good gag reflexChest: no obvious murmurs/arrhythmias, lung fields clear, no areas of dullness.  Panting intermittently but wouldn't call this laboured breathing.Abdomen: no obvious abnsMSN: no obvious abnsSkin/ears/eyes/coat: no obvious abnsborderline pyrexiaddx:tracheobronchitis/ possible low grade pneumonia - inflammatory, occult infection, FB, hypersensitivity.  Less likely anatomical eg megaoesophagus or neoplasticTx/Plan:Rec switching from doxycycline to Amoxyclav 250mg - 1.5 tabs bid PO 7 days - to start tonight, with foodDispensed Codeine 30mg - 1 BID PO - to give first dose when she gets home, then again later tonightTo continue restricting exposure to other dogs and restricted activity + feeding small amounts of soft food - to avoid harder foods Rec imaging tomorrow esp if no change - o to call first thing tomorrow am If coughing worsens/Bille deteriorates ahours, advised to head to AES/SASH emergency overnight

Have reminders been checked? Y Has the owner been advised of this? YHx:Has started dry retching/coughing yesterday. Brought up a little bit of foamOtherwise well. EDDU normallyWas in 4 weeks ago for suspect KC- tx with actacode and resolved. Not on any medications atm Went to daycare last ThursdayUTD preventions. PEx:BAR, mm pk+m crt<2sec. EENT wnl. Cardiac ausc wnl. Lung sounds clear. Abdominal palpation soft and comfortable. Ambulating well. WBx4. LNs wnl.Dx: Infectious tracheitis (refractory vs diffrent strain) vs otherPlan:Doxycycline 250mg PO SID for 7d with food. Isolate from other dogs

Have reminders been checked? noPresented for coughing + vomiting. Vx 1-3 times, sometimes vx when eats too fast. First Vx was food, last two were white foam. Exposed to KC at daycare recently by another dog. Has begun experiencing a dry hacking cough recently, usually when excited. EDDU, slightly more lethargic. PE:  Cardio: Regular rate and rhythm, no murmur detected.  Resp: No wheezes or crackles auscultated, tracheal pinch +veOral: CRT <2s, pink and moist MM. Dentition g1Eyes: Bilaterally symmetrical,  clear and no presence of discharge Ears: No erythema or discharge noted Integument: NAD GIT Palpation: Abdomen comfortable on palpation, no obvious masses Assessment      Ddx: URT - infectious tracheobronchitis > laryngitis, tracheomalacia, etcTreatment Actacode 5mL q6-8hrsRestrict from other dogs for 2-3 weeks