C10007772 / invoice 20000

Appointment Notes: vomiting JRSubjective: Acute onset vomiting today, est 5-6 times. Initially partially digested food, then mostly water/foamy. Definite vomiting with abdominal retching effort involved. Was a bit quieter than usual last night after walk and throughout today too. Normal faeces seen todayDid try to eat a piece of charcoal from BBQ yesterday, O est only a small ~20c coin size piece possibly ingested. Does like to chew things but often spits bits out rather than ingesting them.Was fed some different wet food last night. Usual diet RC and supermarket puppy wet and dry food. Still ate breakfast and lunch as per normal todayObjective: BAR, wriggly. Resistant to restraint for examHR/PR/CV: 100, no murmur or arrhythmias, normokinetic and synchronous pulsesCRT/Hydration: pink and moist, CRT 1s, normal hydration RESP/RR: pantingTemp: 38.5GIT/UG: slightly tense cranial abdomen, very wriggly and resistant for restraint - hard to determine if truly painful vs reactive for restraint reasons. Doesn't consistently react in any particular area. No obvious masses, FB, or organomegaly palpableSkin/Ears: nadM/S: ambulating well Eyes: clear nadDental: G1Lymph Nodes: nadBCS: 4/9Assessment: Acute onset vomiting, lethargyDdx: gastroenteritis (dietary indiscretion, viral, bacterial, parasitic), pancreatitis, GI FB, addison's disease, renal disease, hepatic disease, neoplasia, otherDiscussion with owner: Discussed ddx as above, options for med trial vs w/u with bloods +/- abdo rads - would need sedation to achieve either of these. O's agreed for med trialTreatment: Maropitant 10mg/mL (prevomax) 2.7mL sc - extreme reaction with +++ vocalisation to injection Plan: Recc i/d or boiled chicken and rice in small frequent mealsRecheck INI/worsening, consider bloods and abdo rads f/u call tomorrow Appointment Notes: rm 4 Sore bottom q195Maropitant 160mg has at home motion sickness Subjective: OR over the past 5 days or so Flynn has has watery diarrhoea - O thinks triggered by giving an oral worm tablet. OR she has changed his food recently and often develops diarrhoea when she does this.He has been licking at his back end, which looks very sore. O concerned about his AGsOR he also has motion sickness  - have 160mg cerenia tablets at home from their other dog, wondering if they can use this for him.DUDEBAR in consult - very hyperactive, did not tolerate rectal exam at all without sedationObjective: HR/PR/CV: 90, normokinetic, no murmurMM/CRT/Hydration: pink and moist, 2 seconds, hydratedRESP/RR: lung sounds clearTemp: n/cGIT/UG:  comfortable on palpation, anus erythematous and uncomfortable, did not tolerate rectal exam at allSkin/Ears: NADM/S:  Ambulating well in consultEyes: NADDental: CleanLymph Nodes: NADBCS: 5/9Assessment: > Diarrhoea: Ddx: Gastroenteritis vs dietary hypersensitivity vs stress colitis> High anxiety/cannot control emotions - requires training + sedation for vet visits> Possible anal gland impaction (vs anal irritation from diarrhoea)> Motion sicknessTreatment: > ProKolin 8ml BID PO > Gabapentin 600mg PO night before vet visits, then 900mg PO 2-3 hours before vet visits> Trazodone 300mg PO night before vet visits, then 300mg PO 2-3 hours before vet visits> Advised O can give 1.25 160mg cerenia tablets 2-3 hours before car rides up to once a day (200mg)> Advised O can try flamazine onto anus for comfort - will need to put an e-collar on him to stop him licking it offPlan:> Monitor diarrhoea/anal irritation at home. INI in 7 days, recheck with sedation on board for rectal exam. > O to seek out dog trainer