C10017277 / invoice 10000

Reason: V+, Eating Grass ARAppointment Notes: Overdue remindersSubjectivePresenting Concerns:  Nala, a 12-year 5-month female English-Dashable Terrier, presented for an episode of vomiting and an increased desire to eat grass.    Historical Conditions:-   Known allergy to beef, which causes hives.-   History of environmental allergies.  Diet/Appetite:-   Appetite is reported as good and she is always hungry.-   Diet was changed approximately 2 months ago. She is currently fed a mix of lamb or kangaroo-based commercial foods.-   Receives table scraps frequently, including recent pasta with chicken and sausage.  V/D/C/S:-   Vomiting: One episode occurred 2 nights ago.-   Diarrhea: None reported.-   Coughing: The owner reports a cough, which they attribute to allergies.  Skin & Coat:-   The owner reports that she has been itchy.  Current Medications:-   Recently received a Cytopoint injection for allergies.ObjectiveMentation: BAR  BCS: 6/9  T: Not taken  P: 120  R: pantMM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: Bright and happy during the examination.    Eyes: Watery discharge bilaterally. Otherwise clear with no erythema.  Ears: Clean with no discharge or erythema AU.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: Calculus and gingivitis absent. No masses or other lesions.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: Non-painful on palpation. No organomegaly or mass effects.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin. A firm, SQ mass is present over the sternum. A few other small skin tags are present.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   Fine Needle Aspirate (sternal mass): The sample appeared as greasy fat, consistent with a lipoma.AssessmentGastroenteritis – Suspected secondary to dietary indiscretion (consumption of high-fat food). Pancreatitis is a less likely differential.  SQ Lipoma – A firm mass over the sternum was aspirated and is consistent with a lipoma.  Overweight – BCS of 6/9.  Allergies – Ongoing pruritus and reported coughing may be related to underlying allergies, potentially exacerbated by recent dietary changes.PlanMedications/Treatments:-   Pro-colon probiotic prescribed to support gastrointestinal health.-   Anti-nausea medication was discussed and can be dispensed without a recheck if vomiting returns, provided Nala remains bright and alert.  Diet & Feeding Recommendations:-   Discontinue all table scraps, particularly high-fat foods such as sausage, bacon, and ham.-   Stabilize the diet by selecting one appropriate commercial food. A temporary bland diet (e.g., kangaroo and rice) can be used to transition.-   Implement a weight management plan by reducing treat intake and adjusting meal portions. Low-calorie treats (e.g., green beans) and food puzzles are recommended.-   Add psyllium husk (1-2 teaspoons BID) to food to increase fiber, which may help reduce grass-eating behavior.  Additional Discussion:-   The owner was advised to monitor the lipoma for any changes in size or character. Surgical removal was discussed as a future option if it grows or impedes mobility.-   If pruritus persists, a follow-up discussion regarding alternative allergy management is recommended.-   Return for re-examination if she becomes lethargic, inappetent, or if vomiting persists.    Vital Signs