C10018698 / invoice 10000

CONSULT TIME: 22:30CONSULT ROOM: 11OWNERS IN CONSULT: Ozzy and ClaudiaHistory:Milly, an 8-year-11-month-old Maltese, presented for acute onset vomiting tonight. She has had approximately 8-9 episodes of vomiting, which were described as white and foamy. Small pieces of a tennis ball were noted in one of the vomits. The owners report their other dog had chewed a tennis ball into very small pieces and are concerned Milly may have ingested some. She vomited her dinner and evening medications, which were given in a ball of meat and appeared undigested. She has an increased appetite due to her prednisone medication. She is drinking well and urinating frequently. There has been no diarrhoea, and no blood or melena noted in the vomit or faeces. Prior to the vomiting, she was seen eating grass.Milly is bought in by her owners adult children. Current meds: Prednisone once daily at night, Pregabalin every 12 hours, Trimethoprim - owners didnt know specific doses or any more information.Prophylaxis: Owners unsure of flea, tick, worming or vaccination status.Pre-existing conditions: Suspected autoimmune meningitis, diagnosed approximately 6 months ago and managed by ARH. Clinical signs included near-paralysis from the neck down, with relapsing hindlimb weakness when weaning off prednisone. Mobility fluctuates, with a hindlimb ataxia and truncal sway.Access to toxins eg. Rodenticide: Possible access to a chewed-up tennis ball. Owners also questioned possible cane toad exposure but believe it to be unlikely. no known access to rat bait, human medications, compost, rubbish, plants or any other potential known toxinsDiet: Hills Science Diet kibble.TRIAGE:HR: 120 bpmRR: Pant Normal effortTemp: 38.6°CMM: Pink & tackyCRT: 1-2 secondsMentation: QARPain Scale: 0/4Hydration status (%): Mildly dehydratedEXAMINATION:Body Condition Score: 5/9Cardiovascular: Cardiac auscultation no murmur, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Mild hindlimb ataxia and truncal sway noted. Able to ambulate. Brisk palpebral and menace, full neurological exam not performed.Musculoskeletal: Ambulating with a hindlimb ataxia, no apparent neck, spine, limb or joint pain on palpation, full musculoskeletal exam not performedGastrointestinal:- Oral: no lesions, no ulcerations, no mouth pain, dental score (1-4): 2- Abdominal: no detectable pain on abdominal palpation, no appreciated organomegaly/foreign bodies, normal gut sounds- Rectal: not performed due to poor patient compliance Urinary: small soft urinary bladderReproductive (incl ext genitalia): no appreciated vulval dischargeIntegumentary system: Soft clean coat, no appreciated significant excoriations, lesions, alopecia, ectoparasites, tick search negative. Minimum bilateral cerumenLymph Nodes: peripheral lymph nodes small and symmetricalEyes: bilaterally clear no appreciated inflammation/pain/scleritis/conjunctivitisPROBLEM LIST:1. Acute vomiting2. Suspected foreign material ingestion (tennis ball)3. Chronic hindlimb ataxia secondary to suspected meningitisDIFFERENTIAL DIAGNOSIS:Differentials for acute vomiting would include gastric and intestinal causes (eg. dietary indiscretion, foreign body, infectious, inflammatory, neoplastic, or toxic causes), abdominal disorders (eg pancreatic, hepatobillary, or renal disease or peritonitis) as well as metabolic and endocrine disease. Steroid related. ASSESSMENT:Vomiting and suspected foreign body ingestion. The primary concern is gastroenteritis secondary to dietary indiscretion however cant rule out other causes at this time. TREATMENT SUMMARY:Ondansetron 0.4mg/kg TM TID x 2 daysOWNER COMMUNICATION:Discussed the acute onset vomiting. Explained that potential causes include simple gastroenteritis from eating the tennis ball pieces, a side effect of the chronic steroid medication, or a potential gastrointestinal obstruction, although this is considered lower risk as the ball was in small pieces vs other causes. Options for management were discussed, including symptomatic treatment with anti-nausea medication versus further diagnostics like a triage ultrasound. The owners elected to proceed with anti-nausea medication and monitor Milly closely overnight at home. Advised to offer small amounts of food and monitor for further vomiting, changes in behaviour, or lethargy. Advised to return immediately if concerns worsen or to see their regular vet or ARH in the morning for reassessment.PLAN:Discharge home with ondansetron wafers. Monitor closely at home for ongoing vomiting, lethargy, or inappetence. Reassessment with their regular veterinarian or ARH recommended due to owners not knowing full history and no access to full history and medications this evening.    Vital Signs