C10009056 / invoice 30000

HISTORY: Complaint: ingrown dew claw 

History: 
LH dewclaw grown into pad noticed by groomer recently 
otherwise well 

Physical exam: 
LH floating dew nail grown into pad
clipped, fresh blood but no pus in wound. 
cleaned thoroughly with chlorhexidine 
clipped other dew claw 

Assessments: 
ingrown hind dew claw - O didn't realise she had them as so fluffy 
no signs of bacterial infection currently

Plan: 
O has booked in for desex next week and given quote for desex + bilateral hind dew claw removal

WEIGHT: 5.03
HISTORY: Saw EC at the start of the week for vomiting and diarrhoea 
D+ was clearing up midway but runny again
On heat 3 weeks ago - postponed desexing as unwell but explained needs to wait at least 4 weeks after season has finished

History:
Thursday ate plant (Lavender)
May have ingested other material - O reports Eating everything in yard
O reports Been lethargic all morning
Last few days bringing up bile
Vomited pink fluid today  (daughter was there, not urine)
still doing sloppy stools this morning
** Growling and  defensive with Owner this morning - not normal behavior

EXAM
Eyes ok
Ears ok
MMs pink tacky
CRT <1s
Heart chset clear
HR 160
ABdo palpation: Not nauseous. not painful
Temp 38,7C
5.03kg

DDX: GI upset/dietary indiscretion
Sounds like going on for a while
Discussed fresh blood in vomit vs digested blood => Suspect oesphagitis or gastritis
Discussed prokolin for D+ - diarrhoea for whole week now so DK cosidered AB coverage as well

RX: Trial maropitant to relieve vomiting and refux
Asked about losec or carafate- may be hard to medicate
Owner happy to try metronidazole
RX: 1/4 x 250mg metrobactin BID for 5 days (but gave extra in case needs longer course

Rec Bland diet - treats are rawhide type and not appropriate whilst GI upset

WEIGHT: 5.2
HISTORY: Complaint: GI signs 

History: 
slightly off food for the past week. sometimes turning her nose up but will still eat substantial amounts of the food put out later on that day. 
has always been picky and won't eat kibble, wants human food instead 
vomited as least 6 times over the past few days, but O is unsure of the actual frequency. vomits consisted of white frothy with small amount of grass which O has found around the house 
to tempt her to eat, O cooked meat and vegetables + added a pinch of garlic salt which she ate all of last night and no vomiting after  
has had loose stools for about a week but, this morning was straining and had small amounts of diarrhoea with fresh blood and mucous 
bright, not lethargic 
drinking normally, urinates in yard so unsure re urination 
can be a scavenger. goes after lizards 
on simparica trio 
gets motion sickness, hypersalivates and vomits in the car 

Physical exam: 
extremely bright, alert and responsive 
MMS pink and moist, crt 1-2 sec 
normal skin tent 
dental dx 0/4 
eyes/ears NAD
heart normorhythmic, no murmur detected, difficult to estimate HR as so bouncy 
lung sounds clear, panting as excited 
abdo palp S+C 
anus normal appearance, no redness 
femoral pulses SS 
peripheral LNs NAD
BCS 4/9 

Assessment: 
ddx primary GI most likely (dietary indiscretion, infectious gastroenteritis causing vomiting then colitis, others) 

Plan: 
recommend placing on bland diet with increased fibre to help with colitis. recommend cooked chicken breast + white rice + cooked pumpkin/sweet potato or 1/2 tsp psyllium husk for next 5 days 
advised large amounts of garlic can be toxic so not ideal to add garlic salt to food 
if symptoms not improved in 5d or if worsens in meantime (not eating, lethargic, vomiting more) recommend recheck for further work-up 
discussed cerenia tablets for motion sickness, O declines for now due to cost