C10002275 / invoice 10000

HISTORY: Presenting Complaint: Ataxic, v++ after dinner 
Regular vet: Mosman Park Vets 

HISTORY
Presented for vomiting and weakness. 

Owner reports two episodes of vomiting this evening around 18:00, approximately two cups in volume. Subsequently became very weak, having difficulty standing and walking, taking only a few steps before stopping. Able to walk into the clinic from the car. Owner also reports an increase in panting.
 
Belle has a history of intermittent diarrhoea over the past few months, treated with courses of antibiotics. Previous investigations by the primary vet, including blood and urine tests, revealed proteinuria, raising concern for early kidney disease. A transition to a renal diet and a weight loss program were initiated. A mast cell tumour was excised from the right forepaw interdigital space last year, with complete margins reported on histopathology.

Previously a breeding bitch. 

Primary vet is Mosman Park Vets
Pre-existing conditions:
- Proteinuria, suspected early renal disease on Primary care bloodwork 
- History of recurrent diarrhoea.
- History of mast cell tumour, right forepaw, excised with complete margins.

EXAMINATION
Demeanour: BAR, loves treats 
BCS: 7/9
MM: Pink moist
CRT: <2s
HR: 100
RR: panting
LN: Peripheral WNL
Temp: Not taken due to fear free handling

Eyes: No discharge or erythema, bilateral lenticular opacity 
Ears: No discharge or erythema on external exam
Oral: Grade 1.5/4 
CV: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous
Resp: thoracic auscultation clear sounds bilaterally, respiratory effort increased
GI: no detectable pain on abdominal palpation, moderate organomegaly  
Integ: NSF
MSK: Ambulatory but slow, reduced ROM in stifles
Neuro: Mentation normal, full neuro exam not done
Urinary/Repro: NSF
Rectal: not performed

Hydration status (%): hydration clinically adequate

DIAGNOSTICS:
Bloods were taken for in-house testing:
- Please find attached to the patient record.
> Complete Blood Count
- Significant findings: Mild thrombocytopenia on automatic count, 8-12 phpf on bloodsmear 

> Biochemistry
- Elevated Amylase 
- Mild hypoprotinaemia characterised by mild hypoalbuminaemia 

PROBLEM LIST:
- Vomiting
- Generalised weakness
- Tachypnoea
- Hypoproteinaemia 
- Elevated Amylase 
- Proteinuria (historical)
- History of mast cell tumour
- Possible organomegaly 

DIFFERENTIALS:
- Gastrointestinal - Infectious gastroenteritis, dietary intolerance/indescretion 
- Non-Gastrointestinal - Pancreatitis, neoplasia, Hypoadrenocorticism 
- Infectious cause (e.g. leptospirosis)
- Neoplastic progression (metastasis from MCT)

ASSESSMENT:

Patient's bloodwork is equivocal. Since patient's vitals remain stable and is eating treats very well in consults, treatment as outpatient is appropriate at this stage. Discussed with O that whilst results returns otherwise unremarkable, organomegaly will require investigation - undergoing a specialist abdominal ultrasound may be wise to rule out early abdominal disease that cannot be precluded on bloodwork. Atypical Addisons cannot be completely precluded in this patient at this stage. 
If patient deteriorates overnight, return for IVFT and imaging is recommended

TREATMENT:
Maropitant 37mg SC
Buprenorphine 0.72mg IM 

PLAN:
If patient deteriorates overnight, return for IVFT and imaging is recommended
Referral to VIS and WAVES for formal U/S
WEIGHT: 36.70