C10001573 / invoice 10000

Reason: Foreign body?History:Presenting complaint: Agitation and linear foreign body (red strings) protruding from anus.Pertinent medical hx: Diagnosed with anxiety and is undergoing behavioural training.Current medications: Fluoxetine one tablet daily.Current diet: Kibble and wet food mix.Presented for acute onset agitation, restlessness, hiding, trembling and shaking starting approximately 2-3 hours prior to consultation. Owner then observed red strings protruding from the anus. Suspected to be from a rope toy she was seen playing with earlier today. Owner attempted to gently pull on the string, which caused pain. Appetite is normal, ate dinner at 6:30 PM this evening. No vomiting reported. Bowel movements not observed today.Examination:Mentation: Bright, alert, responsive; very anxious; minimal exam due to anxietyMucous Membrane: Pink, moist, CRT: 1.5sCardiovascular: No murmur or arrhythmia detected. Femoral pulses normokinetic, synchronous.Respiratory: Normal bronchovesicular sounds right and left lung fields.Body condition score: BCS 5/9Abdominal palpation: not performedEENO: No ocular or nasal discharge. No foreign body under the tongue. Integument: No obvious abnormalities detected.Lymph nodes: not assessedRectal exam: digitally removed a ~15mm knot of string materials and a long piece of string about 400mm, at least 250mm already out, no resistance felt. Neurological examination: No cranial or peripheral neurological deficit noted. Full neuro exam not completedMusculoskeletal: Ambulatory, able to rise and ambulate without difficulty. Normal gait.Problem List:1. Linear foreign body protruding from anus2. Agitation/distressDifferential Diagnosis:Gastrointestinal linear foreign body (partial or complete).Diagnostics:A rectal examination was performed with a nurse assisting for restraint. The string was able to be gently teased out and was removed in its entirety. The string was approximately 40cm long.Assessment:Nora presented for a suspected linear foreign body. The string was successfully removed via rectal examination without the need for sedation. The primary concern is the potential for plication if more material remains in the gastrointestinal tract. She will need close monitoring for signs of vomiting, abdominal discomfort, not eating.Client Communication:Discussed the risks of linear foreign bodies, including gastrointestinal plication and obstruction. Explained that we cannot be certain there is no more material ingested. Advised that radiographs may not be useful for identifying fabric material unless there are signs of obstruction. Discussed the plan to monitor at home. Advised to add a bulking agent eg. Cooked pumpkin to the diet to help pass any remaining material. Advised on signs to monitor for that would warrant immediate re-presentation, including vomiting, inappetence, or increased lethargy. A copy of the history will be sent to their regular vet, Vet West Midland. Treatment:No medications prescribed.Plan:Monitor closely at home for vomiting, lethargy, or inappetence. If these signs occur, seek immediate veterinary attention.Add a dietary bulking agent to her food, such as cooked pumpkin or psyllium husk (one teaspoon twice daily), to help pass any potential remaining foreign material.Follow up with their regular veterinarian, Vet West Midland, as planned for her desexing surgery (this Friday).Avoid rope toys in the future.    Vital Signs    MMColour: pink;       Weight: 21.5;       Temperature: not taken;       HeartRate: 84;       RespirationRate: panting;       CRT: 1.5;       

Reason: 3rd Vacc - LWNurse consult:- Current medications: NIL- Current diet: puppy- Parasite prophylaxis: UTD Simparica trio- Desexed: NGeneral History- EDDU normally at home.- No vomiting or diarrhoea seen- No concerns OBJECTIVE: Temp: not taken   HR: 100    RR: 20    MM:  pink, moist   CRT: 2s    - Mentation: BAR. - Body condition: 4/9- Thoracic auscultation: NAD- Abdominal palpation: Soft and comfortable - NAD- Oral examination: NAD- Ocular examination: NAD- Aural examination: NAD - Integument: NSF - Lymph nodes: NAD- Urogenital examination: NAD - Rectal exam: Not performed - Neurological examination: normal mentation- MSK: NADASSESSMENT: Fit for vaxDiscussed diet, desexing, parasite prevention, oral hygiene, isolation period. TREATMENT:C4 protech and BB oralPLAN:Revisit in 6 months.Next vax due 12m--- 17/02/2025 08:52:00 AM WLA:Vaccinations - Resolved - SMS sent. SB    Vital Signs    Weight: 8.8;       

Reason: 2nd Puppy VaccinationAppointment Notes: ------- Sms reply: YCurrent Diet: Blackhawk puppy kibble (no known food allergies)Paraciticides: O unsure diet Current Medication: Panacur & ProkolinHistory:-Last vacc: C3 4/12/24-Went to PVE for D+. Since discharge stools have been liquid.- BAR no V+ EDUCOM- had some loose stools. No blood, just Pippa had blood. Being treated with panacur and prokolin. Seen at PVE- otherwise bright, happy, playful. Gorgeous puppy - DUDE as normal, feeding Blackhawk puppy. No change in food since the breeders.Examination: BARBCS 5/9 Eyes nadEars nad Oral exam nad, juvenile dentitionLNs wnlChest ausc nadCVS nad no murmur no arrhythmia pulses s+s Abdo palp nadRepro/rectal nad externally Skin/integument nadMSK nad Assessment:  Fit for vaccination Ongoing d+ but bright and happy - poss new environment /stress, parasites eg giardiasis/ other. Laboratory:Nil Client Communication: Disc worming, oral hygiene etc. Treatment:  C4 protech given s/c back of the neck BB oral givenSimparica trio sample given Plan:Booster @ 16 weeks. Final vacc.Discuss desexing further at next vaccine - Frontier reccomendations >11mo.    Vital Signs    Weight: 4.8;