C10003579 / invoice 10000

    Vital Signs    

ATTACHED - Swanbourne Vet Clinic Report - Ziggy ChesterCmDx: PRACurrently no cataracts but may  developTara: Was considering sending to behaviouralist but grumpy behaviour may be assoc with decreased vision and pain without meloxicam for a whileMight need to see behaviouralist but would recomm seeing how things settle next few weeks on meloxicam again for pain and as the stress of the all the GI issues settle downSpoke to ownerSeems a bit happier on meloxicamCan give gaba as wellO do feel losing sight is likely a cause of some of his issuesWill adjust things for himMay be going into kennels in april- can give some more gaba to give whilst in there to reduce stress or consider zylkene or adaptil as well    Vital Signs    

Reason:  Tara -  Med Revierw - Has Been VomitingAppointment Notes: the last few mornings AD Summary: Post-bowel obstruction recovery, vomiting, pain management, and aggression.Current history:-  Vomited yellow bile twice last week, a few hours before morning meal. Usually gets fed very early but change in hours so missed early breakfast then vomited bile. Still eating well. No diarrhoea Now being fed three times a day. Bowel movements are now regular and normal post-obstruction. Drinking less, but drinks well after walks.- had gastro just before xmas and ended up at PCEV with laparotomy with suspected fb but nothing found when opened him up. Has recovered well since then- however has always had some behavioural issues - would growl if try and take away somethng he is chewing on etc however this has esculated since sx and now biting at times and won't let o get things away from him. - had been on meloxicam and been on gaba since sx. Has hx of joint issues- bilateral hip femoral head excision, possibly elbow dysplasia as well- is awaiting referral appt to see Dr Chester re eyes- Current medication: Was on Meloxicam, then switched to Gabapentin. Currently on a bland diet.- Known medical conditions: Suspected osteoarthritis (sore hips, front paws). History of bowel obstruction requiring surgery. Vision and hearing deficits noted.- Current diet: Boiled chicken with vegetables, with dry food being slowly reintroduced.**Clinical Exam**- MM: mm pink refill < 2 secs- Oral cavity: G1 calculus - Eyes: Suspected vision impairment; owner notes selective blindness but struggles to see objects like a ball or a bean. Pupils quite dilated as prev noted - Ears: Suspected hearing impairment.- Cardiac: NAD- Respiratory: normal sounds and effort- Abd palp: NAD- BCS: 5/9- Temperature: NT - MSK: Reports soreness in hips and front paws after walks. Owner reports an episode of yelping this morning, possibly due to hip pain.- Skin:ASSESSMENT:- Post-foreign body obstruction: The pet has recovered well from the surgery. Bowel movements have returned to normal. The recent vomiting of bile is likely bilious vomiting syndrome due to an empty stomach, as it occurred several hours post-feeding.- Musculoskeletal pain/Osteoarthritis: The pet is exhibiting signs of pain, including soreness after walks and yelping. The pain may be contributing to behavioural issues. The current pain relief may be insufficient.- Behavioural issues: The owner reports increased aggression, particularly resource guarding (food, items picked up from the ground), which has progressed from growling to biting. This behaviour has worsened since the operation. There is also persistent barking. The aggression may be pain-related, a learned behaviour, or have another underlying behavioural cause. Vision and hearing deficits may be contributing to anxiety and reactivity.Treatment:- Recommendations made to restart Meloxicam for anti-inflammatory pain relief and to observe for improvement in both pain and behaviour. Advised that Gabapentin can be added back in if Meloxicam alone is insufficient.- Recommended probiotics (capsules) to support gut health following surgery and antibiotic use.- Counselled owner on managing bilious vomiting by providing a late-night snack or smaller, more frequent meals.- Discussed the use of a muzzle during walks for safety, to prevent scavenging and to deter others from approaching.- Counselled on the potential for pain to be the underlying cause of aggression and the importance of managing this first.Guess with eye issues and behaviour change can't rule out central neuro issue starting? Maybe worth waiting to hear from eye specialist?PLAN:Restart Meloxicam and monitor response. If pain or behavioural signs persist, can reintroduce Gabapentin.A referral will be sent to a veterinary behaviourist to assess the aggression and provide management strategies. This will also help determine if anxiolytic medication is appropriate.Continue with the current diet and feeding schedule.Advised to use a muzzle on walks.Follow up if signs worsen or if Gabapentin is required. Await contact from the behaviourist service regarding an appointment.    Vital Signs