C10009083 / invoice 10000

On going Diarrhoea. mh
O went to emergency last week. prescribed Loxi. Diarrhoea started ceased Loxi and diarrhoea has continued for 5/6 days 
px history to be attached

Verified: NO

HISTORY
Presenting for: Patient presented for ongoing diarrhoea following recent surgery, with owner reporting panting and unsettled behaviour initially thought to be surgery-related
Historical Conditions: Recent surgery with post-operative assessment revealing back pain on palpation by surgeon, lungs checked and found normal
V/D/C/S: Diarrhoea ongoing since Wednesday, initially large volume watery consistency, now progressing to increased frequency with smaller volumes, mucous and flecks of blood present, described as spraying out
Current Meds: Meloxicam (started Wednesday), multiple other medications post-surgery, up to date with worming and vaccinations
Diet: Currently eating only chicken and pumpkin, not wanting to eat regular food

EXAM
Mentation: Bright and alert
Hydration: Not dehydrated
Behavioural: Bright in himself, not lethargic
Abdominal: Gas sounds audible on auscultation, gas movement palpable
Musculoskeletal: Back pain noted on palpation
Rectal: Digital rectal examination performed, mucous and blood noted consistent with colonic inflammation

ASSESSMENT
Gastroenteritis - progression from small bowel to large bowel involvement evidenced by change from large volume watery diarrhoea to increased frequency with smaller volumes, mucous and blood. Multiple potential causes including drug-induced (Meloxicam), infectious (viral, bacterial, parasitic), or other gastric upset

PLAN
Diagnostics:
- Faecal sample for canine diarrhoea panel discussed - $290, client to collect sample and bring in as soon as possible, can refrigerate if unable to bring immediately
Changes to Existing Medications:
- Discontinue Meloxicam due to diarrhoea
- Continue probiotics BID as much as possible despite patient's reluctance
Diet Recs:
- Transition from current chicken and pumpkin to Royal Canin gastro-specific wet food for easier digestion and balanced nutrition if treatment extends beyond a couple of days
Additional Discussion:
- Monitoring timeline discussed - can continue current supportive care as long as patient remains bright and not dehydrated
- Infectious gastroenteritis duration variable depending on causative agent, some require specific treatment while many viral causes are self-limiting

SASH history attached. MH 

ahc & vacc sm

Verified: NO


HISTORY
- Dog becomes very excited, leading to breathing difficulties
- No blue discoloration noted during episodes
- Previous note of being extremely noisy on examination

EXAM
Respiratory: Noisy breathing noted, particularly when excited

DIAGNOSIS
- Suspected airway obstruction or anomaly

PLAN
- Recommend assessment of airways under anaesthesia as only definitive examination possible in this state
- Possible airway surgery depending on assessment findings
- Check insurance details and ensure coverage for the procedure
- No referral needed for specialist consultation at SASH or VSS Carrara
- Owner to contact insurance regarding coverage specifics