C10006253 / invoice 10000

Possibly sore mouth, admitted for exam and bloods

History:
O has been away over weekend and Coco staying with a friend. She's spent a lot of time playing rough with friend's dog and running around down at river. On friday she was sneezing a little in the car on way to park but was then normal at park. Mild watery nasal discharge on Saturday, not her usual exuberant self. Discharge resolved quickly
Sleeping more than usual and not herself, a bit lethargic. New bad breath noted, O thinks she might be sore in her mouth, not grabbing toys normally and not eating as well as she usually does, although she did have some kibble this mornigng
She was given dehydrated chicken breast and beef chews by friend over weekend, they're not paticularly hard. 

DEMEANOR: BAR, anxious but sweet girl
TEMP: 38.4
HR/PULSE: WNLs, no murmur auscultated in the consult room today QUAL: normal
RR/EFFORT/THORACIC AUSC: wnls, chest clear, normal effort
MM: pink, increased salivation
CRT: instant (difficult to assess, really resents mouth exam)
Ears/eyes: nad
LN: wnls
ABDO PALP: tense but nad
MSK: nad, full msk exam not performed today
INTEG: nad
NEURO: neuro exam not performed today
BCS: 4/9

Assessment/problem list:
Oral discomfort - possible soft tissue injury, foreign body, or TMJ issue. Increased salivation. Abnormal odour from mouth. Cannot achieve good oral exam conscious

Treatment:
Twilight sedation for oral examination. Bloods for comp including inflammatory proteins and white cell count. 
Trial anti-inflammatory +/- anti-nausea if no abnormalities found. 
Possible X-ray of mouth/TMJ if questionable findings on sedated exam.

Plan:
Hospital stay for twilight sedation and oral examination. Full mouth examination including teeth probing, roof of mouth, back of tonsils. 
Comp bloods 
Will call owner if abnormalities found that require additional workup. 
Discharge 5:45pm (confirmed-needs to be coordinated with work). Gap only claim with Everyday Pet Insurance.

Estimate: upto $800

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Handed to MT
premed 0.2ml meth 0.1ml acp im
induced 7mls prop
creaty = ,159 usg - highly conc
crp = 5.7

Urinalysis
USG 1.040
Glucose - Neg
Bilirubin - Neg
Ketones - Neg
Blood - Neg
Ph - 6.5
Protein  -  +
Urobilinogen - Neg
Nitrates - Neg
Leucocytes - Neg 

jaw movement normal
teeth all ok, no fb seen in mouth. pharynx normal, tonsils up a little ? 
SMLns enlarged moderately 
temp 39.4 on induction but was very anxious in here 
gums quite inflamed
ears ok
neck movement ok
jaw opening nice and wide and nonpainful before any premeds given and moving normally after prop

Plan: seems likely coming down with an infection - upper resp ? Was possibly a bit snuffly a few days ago?
gave melox 0.27ml sc
home with melox for a few days 0.4ml sid with food
softer foods for a possible sore throat?