C10001088 / invoice 10000

Reason: Y  - V++ TYLHISTORY:Beau is a 6-year-old, 48.5 kg, male neutered American Bulldog who presented for vomiting today. He had several episodes of bile vomiting this morning but was still eating afterwards. The owner reports that this is the highest frequency of vomiting he has experienced in a single day.Beau has a chronic history of vomiting and has been seen by other veterinarians on three previous occasions with no definitive diagnosis. He is currently on a hypoallergenic diet, which was started because he vomited frequently on a raw meat diet. Despite the diet change, the vomiting persists.Typically, Beau will eat grass for 10-15 minutes, have two episodes of vomiting (initially grass, then the remainder), and then seem fine. Today, he vomited twice at 3 AM and twice at 12 PM. The vomiting is preceded by restless behaviour, including jumping on his crate door. The emesis is described as a full abdominal heave, not regurgitation. The vomit contains bright bile and froth, with no food material present. The vomiting is not associated with feeding times and occurs sporadically. There is no associated diarrhoea, and his stools are normal, although there was some clear fluid expressed with his stool this morning.He is an indoor dog and only goes outside for toileting supervised. There has been no change in his water intake.Recently, within the last few days, Beau has been reported to lose his balance and his legs have been collapsing when he goes to sit. He has also been supposedly haking in his sleep for the past 12 months. On presentation this was not evident and the patient managed to sit for a blood draw. There has been weight loss reported by the owners, from 60 kg to a current weight of 47 kg over the last 12 months. Current medications: Ondansetron 4 mg (half of an 8 mg wafer) given in peanut butter after each vomiting episode.Prophylaxis: Pre-existing conditions: Chronic vomiting unaffected by season and not associated with any events (e.G. Feeding, going outside). Appears to be more focused on the afternoon.Access to toxins eg. Rodenticide: Not mentioned.TRIAGE:HR: 100 bpmRR: pantTemp: 39°CMm: pink, moistCrt: <2 secondsMentation: BAREXAMINATION:Body Condition Score: 4-5/9Pain Scale (0-4): 0Hydration status (%): Euhydrated.Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait detectedMusculoskeletal: Sits for blood draw. Otherwise ambulating normally, no palpable neck, spine, limb or joint pain.Gastrointestinal:- Oral: no significant findings, no mouth pain- Abdominal: Discomfort on abdominal palpation, but no overt pain. Able to palpate deeply.- Rectal: not performedUrinary: no significant findingsReproductive (incl ext genitalia): no significant findingsIntegument/Ears: no significant findingsLymph Nodes: no significant findingsEyes: no significant findingsPROBLEM LIST:- Chronic vomiting- Recent onset of hindlimb weakness/ataxiaDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Open diagnosis GI vs extra GI DIAGNOSTICS:PC/TPPCV: 51%TP: 72 g/LSerum: clearInterpretation: Mild haemoconcentration consistent with subclinical dehydration.Blood Gas Analysis Results - source: venousFindings: PCO2 44 mmHg. Electrolytes normal. Bicarbonate levels slightly elevated.Interpretation: The elevated PCO2 is unusual in a stressed, panting dog, but is not considered clinically concerning at this time. Bicarbonate elevation is consistent with vomiting. Electrolytes are within normal limits.ASSESSMENT:Beau is a 6-year-old male neutered American Bulldog presenting with an acute exacerbation of chronic vomiting. The history is significant for long-standing, intermittent bile vomiting unresponsive to dietary changes and fasting. New clinical signs include ataxia/hindlimb weakness and significant historical weight loss.On examination, Beau is bright and alert, with stable vital signs, though his heart rate is mildly elevated, likely due to excitement. He is euhydrated on examination however gums can be moist due to hypersalivation. Abdominal palpation elicits some reaction but not repeatable and no distinct pain. He has a good body condition score despite the reported weight loss.Blood gas analysis revealed a mildly elevated PCO2 and bicarbonate, with normal electrolytes. PCV/TP indicates mild haemoconcentration.Given the chronic nature of the vomiting, significant weight loss, and new neurological signs, a comprehensive workup is warranted. Referral to an internal medicine specialist for further investigation, including full blood work and abdominal ultrasound, is strongly recommended to investigate underlying causes such as chronic enteropathy, pancreatitis, or other systemic disease.TREATMENT:Cerenia (maropitant) 1 mg/kg administered subcutaneously at 6:30 PM.THM Cerenia 60mg PO SIDTHM Ondansetron 8mg PO BID-TIDPLAN:- Refer to VSS IM for further investigation as soon as possible.- If vomiting persists despite antiemetic therapy, there is concern for a potential gastrointestinal blockage, and he should be re-evaluated immediately.CLIENT COMMUNICATION:Advised the owner that Beau is stable to go home with antiemetic medications. The importance of referral to an internal medicine specialist for a full workup was stressed, given the chronic history and new clinical signs.Home care instructions were provided:- Administer maropitant one tablet every 24 hours, with the next dose due tomorrow at 6:30 PM.- Administer ondansetron by placing the tablet onto his gums every 12 hours. This can be increased to every 8 hours if nausea is noted towards the end of the dosing interval.- Ensure he has access to plenty of fluids.- Book an appointment with an internal medicine specialist as soon as possible.- Advised owners that if any deterioration is noted, such as ongoing vomiting despite medication or worsening of his general condition, to represent for reassessment immediately.    Vital Signs    

Reason: Sore Eye VRHISTORY:19 dec presented to AES for right eye conunctivititisT chlorpt neg flu stainRubbing eyeOther dog at home licking eyeTOday eye completely closedRepresetned tonight post 12 daysCurrent meds:Prophylaxis:Pre-existing conditions:Access to toxins eg. Rodenticide:TRIAGE:HR: 20RR: 20Temp: 38.3Mm:  pinkCrt: <2Mentation: BAREXAMINATION:Body Condition Score: Pain Scale (0-4):Hydration status (%):Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  - Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: no detectable abnormalities Urinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSF, mild conjunctivititisInflam of eye lids, normal palpebral reflexNo ocular dischargePROBLEM LIST:Right eye inflammation and irritation progressive despite eye ointmentDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Likely irritation secondary to 11 days chloropt treatment, and other dog licking at eye and Beau pawing at eye. Cannot rule out foreign body behind third eyelid, but would expect inflammation to be much worse. DIAGNOSTICS:Anaesthesia: Local Corneal with 1 drop of  amethocaineA fluorescein stain was performed, the findings of this test were:- right: no stain uptakeASSESSMENT:Beau initially presented on the 19th December with right eye irritation.  Despite chloropt eye ointment there has been progression of clinical signs.Direct Ophthalmic was performed where no significant findings were detected.Mild erythema and Chemosis of conjunctiva was noted as well as mild Inflammation of the eye lids.Likely irritation secondary to 11 days chloropt treatment, and other dog licking at eye and Beau pawing at eye. Cannot rule out foreign body behind third eyelid, but would expect inflammation to be much worse. TREATMENT:Voltaren right eye q 12 hourlyPLAN:Stop chloropt ointment and revisit AES over the weekend if not resolving--- 03/01/2022 14:09:35 PM NLG:Examinations - Resolved -    Vital Signs    

Reason: Sore Eyes TRWHISTORY:R eye appeared swollen to the point of closing approx 2 hours ago. Very irritated, scratching at it.Has since resolved significantly but some redness remaining.TRIAGE:HR: 104RR: 32Temp: 38.2Mm: PinkCrt: <2sMentation: BAREXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 1Hydration status (%): EuhydratedCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): 1- Abdominal: no detectable pain on abdominal palpation, normal gut soundsUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: conjunctival and scleral erythema, mild chemosis R eye.PROBLEM LIST:R eye irritationDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Conjunctivitis, traumatic injury (to corneal, conjunctiva or other structures), allergyDIAGNOSTICS:Fluoroscein uptake negative R eyeASSESSMENT:No ulcer evident. Conjunctival irritation may be allergic, infectious or traumatic in originTREATMENT:Tricin BID x5d in R eye.PLAN:O to monitor at home. Any further irritation or deterioration to contact AES or RV for reassessmentCLIENT COMMUNICATION:--- 27/12/2021 19:59:27 PM NLG:Examinations - Resolved - Follow up SMS sent    Vital Signs