C10001592 / invoice 10000

Reason: D+ Appointment Notes: d+ o. has been away & returned home early for dogs. doesn't have car, may need to cancel app.  CCSHReason: History: OR diarrhoea for the past week, was straining midway through the week with small amount of fresh blood on the faeces. Last night had mucous in stool. When picked up on Sunday evening and Monday regurgitated food and then bile vomit. O unsure if been receiving Zactin everyday with the pet sitter, O has noticed personality has been different since she got home a week ago. Used to be fussy with food but is now eating biscuits that wouldn't usually. O believes the pet sitter has been feeding different food. OR demeanour has been more flat, lethargic.Diet chicken and rice since Wednesday, had biscuits last night. Started prokolin paste today. Missed dose of Zactin yesterday. Examination: Laboratory: Assessment: Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:    Vital Signs    

Reason: History: History of anxiety. Owner has fostered before but notes this level of anxiety is severe. Anxiety is directed towards humans and loud noises, but not other dogs.Initial behaviours included hiding, especially from visitors (e.g., hiding under a bush for hours).Over the last two months, behaviour has changed from avoidance to standing ground and fighting back with the other dog in the house, particularly around foodCrate trained, good response Exhibits separation anxiety, noted by barking when the owner is not home. Vocal and reactive to people.Behaviour has gradually improved since starting on fluoxetine over a year ago.The owner will be away for three months (February to May).Current meds: Fluoxetine 10mg (half a 20mg tablet) daily. Trazodone 20mg used PRN for stressful events like storms or visitors.Parasite control: Not mentioned.EXAMINATIONDemeanour: BAR Anxious.BCS: 5/9 not discussedMM: Pink moistCRT: <2sHR: Not assessedRR: WNLLN: Peripheral WNLTemp: Not taken due to fear free handlingPROBLEM LIST:Generalised anxietySeparation anxietyReactivity to humans and loud noisesInter-dog aggression with housemate (recent onset)ASSESSMENT: Separation/generalised anxiety Some improvement with SSRI therapy however O concerned when going away next year about response Recommend seeking vet behaviour as second opinion, can implement trainingBut O has already implemented most techniquesTREATMENT:Continue Fluoxetine: Continue 10mg (1/2 of 20mg tablet) PO once daily. Prescription provided for Bloom's pharmacy.Trazodone: Increase dose to 40mg (two 20mg capsules) PO PRN for stressful events. Prescription sent to Clinicare.Gabapentin was discussed as a potential addition but owner wishes to avoid further medication at this stage.PLAN:Continue current behavioural management strategies: Crate training (safe space), desensitisation, positive reinforcement, establishing routine, and providing self-soothing activities (e.g., lick mats, Kongs).Trial separation periods to build independence before the owner's extended trip from February to May.Discussed chemical castration (Suprelorin implant) as a diagnostic tool to assess for hormone-related behaviour before considering surgical castration. This can be revisited if the owner wishes to explore this option.Referral to a veterinary behaviourist was recommended and discussed. Owner to consider this and contact recommended specialists Waitlists can be 4-8 weeks.Re-evaluation advised, recommending a longer 30-minute consultation for follow-up to adequately address the complexities of a two-dog household.CLIENT COMMUNICATION:Discussed the nature of anxiety in dogs, noting it is a condition to be managed, not cured. Explained the roles of a general practice vet versus a veterinary behaviour specialist. Discussed behavioural modification techniques including crate training as a safe zone, structured routines, and enrichment toys. Advised on using high-value food rewards for training, while managing food aggression between the dogs by feeding separately. Explained the options for castration, including the benefits of chemical castration as a reversible trial. Prescriptions for fluoxetine and an increased dose of trazodone were provided. Advised to book a longer consult for the next visit. Owner understands the plan.Rx:	Fluoxetine 20mg tablets		.Mitte:	 28x tablets Directions:                 Give HALF a tablet one daily ongoing. Do not stop suddenly2x repeatsKEEP OUT OF REACH OF CHILDRENFOR ANIMAL USE ONLYRx:	Trazodone 40mgMitte:	 20x capsulesDirections:                 Give ONE capsule 2hours before stressful event NO REPEATSKEEP OUT OF REACH OF CHILDRENFOR ANIMAL USE ONLY--- 17/12/2025 10:38:30 AM GR6:Examinations - Resolved -    Vital Signs