C10001309 / invoice 10000

Appointment Notes: upset tummySubjective: In today for history of vomiting since Wednesday (04/03).On Wednesday did a very big vomit containing lots of bile and grass. Only had small amount of breakfast yesterday- but ate dinner last night, no witnessed vomitThis morning noticed lots of regurgitated grass in the yard.Would not want breakfast this morning - behaviourally very flat Other dog at home fine, no symptoms. UTD on preventatives - 1st of every month, gave on Mon/Tuesday. Endoguard - 225mg oxibendazole and 50mg praziquantel. Received 1 tablet. Never had this particular one before.Is a chewer - chews branches off plants, plastic, pegs anything. No history of FB ingestion. Defecating normally, no diarrhoea. Objective: QAR, quite flat in consult, usually very active and playful. Cardio: 140, normokinetic, no obvious murmur or arrhythmia   Temp:  39.0MM/CRT/Hydration: pink, slightly tacky MM, <2s, no delayed skin tent. RESP: clear, normal bronchovesicular sounds   GIT/UG: slightly tender on abdominal palpation, firm faeces felt on rectal palpation.Skin/Ears: Clean coat, well groomed. Ears free from discharge on external exam of the internal pinnae.  M/S: ambulating fine   Eyes: clean and bright  Dental: Gr0/4   Lymph Nodes: wnl   BCS: 5/9 Discussed with O that given she has a hx of chewing foreign material, and that she is only v+ with no d+ I am more suspicious of FB ingestion vs gastroenteritis. Advised O I think best option is to admit for radiographs and IVFT for further investigation. O opted to admit for radiographs. Estimate provided and consented. Paid $500 deposit.  Assessment: Acute vomiting ddx: FB ingestion, gastroenteritis, dietary indiscretion, toxin ingestion, intussusception, hepatic disease, renal dz, pancreatitis, neoplasia, other.5% dehydration. Treatment: Nil for now Plan: Admit for IVFT and radiographs for FB investigation. =========================================================================Laboratory: GHP all wnl except: ALT High 131 U/L [10 - 125] - gastroenteritis, hepatopathy (infectious vs inflammatory), toxin ingestion, PSS, other Treatment: Maropitant (10mg/ml) 0.72mL i/vPremed: Medetomidine (1mg/ml) 0.1ml  + Methadone (10mg/ml) 0.2ml i/v Started 53ml/hr hartmanns (Adjusted for 5% dehydration as per AES fluid chart)  Nails trimmedImaging: 1 > View: R Lateral abdo  Factors: 11cm 80kvp 1.4mas Quality: Positioning good, label present, sandbag artefact, collimation good, good exposure. 2 > View: L Lateral abdo Factors: 11cm 80kvp 1.4mas Quality: Positioning good, label present, sandbag artefact, collimation good, good exposure. 3 > View: DV abdo Factors: 13cm 80kvp 2.0mas Quality: Positioning good, label present, sandbag artefact, collimation good, good exposure. Findings Normal: diaphragm intact, stomach fairly empty, good serosal detail, bladder intact, lumbar spine ok, visible long bone density ok, nil pelvic fractures, abdominal wall intact. Microchip present in dorsum. Normal bowel population with no gas distension. Findings Abnormal: Possibly mild opening of tibial crest growth plate bilaterally (incidental) Conclusions: No obvious FB present cannot rule out 100%. No obstructive pattern present.Recommendation: Supportive care at home with maropitant on board and bland diet. Advised if in pain can administer baby liquid panadol. If continuing to vomit, consider repeat abdo xrays to assess gas movement Recovery - Reversal 0.01mL atipamazole i/m @ 6.10pm (1:10 dilution)Plan:Discussed with O on discharge: Bloods fairly unremarkable. Showed radiographs on the computer and discussed not seeing an obstructive pattern and stomach not distended, although we cannot 100% rule out a foreign body as the opacity may be similar to soft tissue and she may just be able to pass it naturally. Advised she is a bit drooly and quiet due to the sedation given to her.Start bland diet - chicken and rice or i/d tomorrow morning. Skip dinner tonight due to the sedation. If wanting to give pain relief -  Panadol liquid (baby)(100mg/ml) 0.72 mls to give PO twice per day.Advised if she vomits over maropitant injection to bring her back in over the weekend. INI - u/s, repeat xrays +/- possibly ex lap.FUC tomorrow - how is she?     Vital Signs    Weight: 7.2;       

Reason: VaccinationSubjective: No concerns at homeEating well - RC dry puppy food and cooked pet foodUD normally, no V or DNo pruritis or lamenessDue for wormingPrevious skin lesion on ventrum has resolved, has a new similar lesion  Objective: Nice girl HR/PR/CV: 100, no murmurMM/CRT/Hydration: pink moist, normal skin turgor RESP/RR: regTemp: neGIT/UG: NAD Skin/Ears: Small firm mobile subcut mass approx 5mm in diameter with small firm plug in centre (looks like a cyst/pimple) RHS of ventral thorax. No umbilical hernia or hind dew claws. M/S: NADEyes: NADDental: only able to examine quickly, appear NAD Lymph Nodes: NADBCS: 5/9Assessment: Suitable for vaccinationTreatment: Protech C4 s/c inj Batch #5257034B 25.06.2026Plan: Vaccination annuallyOther dog is on Simparica Trio, O happy to start this with Pepper also Monitor skin mass and recheck INI or any deterioration Discussed waiting until has had one season prior to desexing if any concern with mildly hooded vulva__________________________INSURANCE HXInitial Assessment > Due for vaccinationSuspected cause > Due for vaccinationDate of first clinical signs > 05/05/25Any other conditions / treatments > No    Vital Signs    Weight: 3.0;       

Reason: Puppy vaccinationHistory: IOP 2wks > settled in well, toilet training/general training going well. EDUD all ok, good appetite, toileting normally. No c/s/v/d.Current diet = rc puppy dry + training treats Due worming. Had 1st vacc with breeder C3. Happy and bright, O has no concerns Subjective:  bar, sweetest girl!Objective: Microchip scanned and working: #956000019560488HR/PR/CV: 120, auscultation nad, no murmur or arrhythmia PULSE: normokinetic and synchronousTemp: 38.0MM/CRT/Hydration:  pm, <1sec, normal skin turgor, adequate hydrationRR/RESP:  24, lung fields clearGIT: abdominal palpation comfortable and unremarkable, no hernia U/G: slightly hooded vulva, mild urine staining of fur around vulva. Skin/Ears: > 5mm firm mobile sc/dermal mass R ventral abdomen. Cytology - neutrophils, occasional macrophage, no bacteria. > Healthy skin and coat otherwise, ears clean externally  M/S: ambulating normally, HL and FL joints comfortable on ROM Eyes: clearDental: deciduous dentition. Very mild mandibular prognathism (upper and lower incisors in line with each other/slot in the gaps beside each tooth; no trauma on surrounding gingiva/no base narrow issues). Lymph Nodes: nad BCS: 5/9Assessment: 1. Fit for vaccination 2. Mass ventral abdomen > inflammatory cells, no bacteria > ddx: sterile granulomatous inflammation (trauma/playfighting with other dog at home, insect bite, penetrating trauma in garden etc). Treatment: BronchiShield Oral Batch #5245041B 01.04.2026Protech C4 s/c inj Batch #5257032B 29.05.2026Discussion with owner: Discussed socialisation and PPS (already booked in at Petbarn). O already has pet insurance for Pepper Went through vacc boosters and worming protocols Discussed desexing – timing, procedure etc.  Plan: Monitor swelling on abdomen, r/c if any concerns or if not resolving in next 7-10d. Final protech C4 booster in 4wks time. Then first adult vaccination April 2026Drontal q1mo until 6mo, then q3mo. Vs monthly combination product eg nexgard. Desexing at 6moRecommended wiping around vulva with unscented baby wipe regularly to keep clean. Monitor hooded conformation as Pepper grows.    Vital Signs    Weight: 2.16;