C10015279 / invoice 10000

AI Consent given - Elizabeth Petriw

Unwell puppy - had some D+, possibly from feeding new food/vegetables. Bright and happy.
History; Final puppy vaccination and concerns regarding an upset tummy. He ate a large quantity of vegetables (cauliflower, broccoli, carrot) for the first time. He subsequently vomited that night and had diarrhoea throughout the night. Stool was normal during the day, followed by diarrhoea again at night. Diarrhoea contained mucus, with no blood. This has been ongoing for more than 24 hours. There was concern regarding potential slug/snail bait exposure, but he did not ingest any. One eye consistently has more discharge than the other. Collar has become snug.

Previous diagnosis/ health conditions; -
Current medications;nil

Toileting; Diarrhoea with mucus present, no blood.
Diet brand & frequency of feeding;Optimum puppy food.
Parasite control up to date? Brand? ?

Clinical Examination;
Demeanor BAR, happy
FAS level -
Eyes Ectropion present bilaterally, discharge noted.
EARS nl
ORAL EXAM;Gums pink, CRT nl.
HR/Pulse ~160 bpm, regular, no murmur.
RR & Qual nl
Lymph nodes nl
Abdo palp sl runny intestines, no pain on palpation.
Skin & coat Normal skin tent, not dehydrated.
Muscle quality/BCS Gained 0.8 kg since last visit.
Joints nl

Problem list
Gastrointestinal upset - vomiting and diarrhoea, no blood.
Bilateral very mild ectropion.
Collar too tight.

DDx;
Dietary indiscretion (high fibre vegetable intake).

Diagnostic tests;nil

Recommendations;
Dispense probiotics for a few days to help normalise gut flora.
If diarrhoea persists, commence ProKolin (over-the-counter) to help bind stool.
Advised to check collar fit weekly, ensuring two fingers can fit underneath.
Can clean gunky discharge from eye corners with a tissue as needed.
Monitor for improvement.

Diagnosis Gastrointestinal upset secondary to dietary indiscretion. Bilateral v mild ectropion.

Prognosis;ok

Treatment; Options
Probiotics.
ProKolin  prn.


Plan; Monitor response to probiotics. If diarrhoea persists, start Procolon. Recheck if not improving.

Next appointment booked no
  set desexing reminder 
.

History:
Presenting for final puppy vaccination. No adverse reactions to previous vaccinations.
Owner concerned about potential ingestion of slugs/snails. No snail bait on property.
History of eating weeds, bark, and a blue stick. Owner reports a single episode of coughing at 5 am, possibly related to irritation.
Appetite is good. Currently fed dry food twice daily. Owner was advised to increase food quantity as he grows.
Energy levels are good.
Worming is up to date. Owner purchased a chewable tablet previously recommended.

Physical Exam Findings:
Mentation: Bright, alert, responsive.
Behaviour: Active and curious during examination.
Eyes: Normal.
Ears: Normal.
Oral Cavity: Teeth are in good condition. No malocclusions noted. Permanent teeth are expected to erupt soon.
Cardiovascular: Heart sounds normal. No murmurs. 
Respiratory: Lungs clear. 
Abdomen: Soft and comfortable. No umbilical hernia.
Urogenital: Both testicles are descended.

Assessment:
Problem list:
1. Puppy behaviour: pica (eating non-food items), licking urine.
2. Vaccination due.
3. Parasite prevention discussion.
4. Desexing discussion.

Plan:
Vaccination administered.
Discussed parasite prevention options: NexGard monthly with an allwormer every 3 months, or Bravecto every 3 months with an allwormer, or Simparica Trio. Advised NexGard does not cover tapeworm.
Discussed desexing, recommended after 6 months of age for small breeds. Advised on advantages (reducing certain behaviours) and disadvantages (risk of obesity, rare risk of incontinence). Discussed surgical procedure and recovery. Advised of alternatives - superlorin implant. 
Recommended a slow feeder to slow down eating.
Advised on signs of gastrointestinal obstruction (vomiting, inappetence) if he ingests foreign objects.
Advised on nail clipping technique, including identifying the quick and using soap as a home remedy for bleeding.
Provided information on parasite prevention and puppy school options.
Owner has pet insurance.

Communications:
Discussed puppy behaviour, including pica and licking urine, advising it is normal but to monitor for gastric upset.
Discussed parasite prevention, desexing, and nail clipping with the owner.
Provided a vaccination sticker for the owner's records.
Will send a reminder for next vaccination in one year.
Advised owner to book for pre-desexing consult when ready.