C10007221 / invoice 10000

10/03/2026 
NURSE: Mon

REASON: Inappetence and lethargy

HISTORY:
- Vomited Friday, food only, single episode. Sunday noted flat, not excited, spending time mooching, not interacting with other dogs. Inappetent since - ate small amount Sunday night, refused breakfast Monday, ate ~1/3 dinner Monday, small amount breakfast Tuesday. Tried soft food/single protein roll, no improvement. Not interested in cheese.
- Hx GI issues June last year. Known arthritis in shoulders. Has 2-3cm soft tissue mass ventral thorax being monitored.
- Yearly vaccinations last Tuesday. Seen at Kingston, NAD at that visit.
- Recently started Fortiflex with meals (Audrey's recommendation), only few days, minimal intake.

APPETITE: Decreased since Friday. Refusing normal food, minimal interest in treats.
ACTIVITY: Lethargic, flat, not interested in hose/play like usual.
DIET: Usually running, stopped due to arthritis. Now walks 30-40 mins max. No strenuous activity recently.

CLINICAL EXAM:
- Mentation: QAR
- MM: Pink, slightly tacky
- CRT: 0.5s
- Oral and Dental Score: Grade 1, some wearing.
- Eyes: Moderate bilateral nuclear sclerosis, otherwise clear.
- Ears: Externally clean.
- BCS: Not assessed.
- Lumps: 2-3cm diameter soft tissue mass ventral thorax.
- Abdominal: Mildly tense but unremarkable.
- Lymph nodes: Peripheral lymph nodes NAD.
- HR: 78bpm, no murmur.
- RR: Clear lung sounds.
- Temp: 39°C.
- Urogenital: Not assessed.
- MSK: Muscle wastage in HLs, crepitus L stifle, moderately reduced ROM both hips.
- Skin: Not assessed.

ASSESSMENT:
- Temp 39°C - upper end normal, possible low-grade fever.
- Inappetence and lethargy - cause unclear.
- Bilateral hip arthritis with reduced ROM and muscle wastage HLs.
- L stifle crepitus.

DISCUSSION:
- Discussed possible low-grade fever contributing to lethargy/inappetence.
- Vaccine reaction considered unlikely given 5/7 since vaccination and no prior issues.
- GI upset possible given Hx and initial vomiting.
- Arthritis pain may be contributing.
- Plan A: Trial paracetamol - pain relief and antipyretic. Reassess in 24 hrs.
- Plan B: Bloods if no improvement.

TREATMENT:
- Paracetamol - label provided, OTC from chemist/supermarket.

PLAN:
- Paracetamol BID x 3/7.
- Bland diet, soft foods.
- Reassess in 24 hrs for improvement.
- If no improvement, bloods.
- F/U next week to discuss arthritis management.