C10019197 / invoice 10000

Reason: 6 Months Check Up For More MedsAppointment Notes: Needs 2 x boxes of vetmedin 1.25mg as welllast check was in in Sept 2025HISTORY:  Presented for assessment of recent behavioural changes and owner concern regarding a "rattling" sensation felt on the chest. The owner reports that for the last few weeks, the dog has been lying on the floor instead of the couch, which is abnormal behaviour. This started around the time their other dog, Oscar, passed away. She is also noted to be more clingy and jealous. The owner's father recently felt a rattling sensation on her chest, described as similar to congestion. There has been no observed coughing or respiratory distress. Appetite, thirst, and urination/defecation are normal. The owner reports apparent weight gain, which may be related to accessing the other dog's renal diet food in the weeks prior to his passing. The dog is still active, managing stairs without issue. There is a history of pancreatitis precipitated by macadamia nut ingestion, and a separate incident of toad toxicity. Resting respiratory rate is generally in the low 20s.Current meds: Frusemide 20mg , dose was recently increased by the owner from 1/4 tablet daily to 1/2 tablet daily due to concerns about the rattling.Vetmedin 1.5 x 1.25mg  BID Vaccination: C5 is up to date, but kennel cough component is overdue.Parasite Prevention: UTD. NexGard Spectra.Pre-existing conditions: Congestive heart failure diagnosed 6 months prior at an emergency centre. History of pancreatitis and colitis secondary to macadamia nut ingestion. History of toad toxicity.Access to toxins eg. Rodenticide: none.EXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation - grade 5 / 6 heart murmur with  normal rhythm, pulse pressures ok and synchronous. Mm pink CRT 1 <2s  No crackles auscultated.Respiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge.Neurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint pain.Gastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): not graded- Abdominal: Tense on palpation, guarding. No obvious fluid wave detected.- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: Quiet but alert. Tense during examination.PROBLEM LIST:- History of rattling sensation on chest wall- Behavioural change (sleeping on floor, clingy)- Weight gain (6.9kg in September to 7.8kg today)- Tense abdomen on palpation- Known congestive heart failureDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:- Stable congestive heart failure- Possible behavioural changes secondary to loss of housemate- Weight gain, likely due to dietary indiscretionDIAGNOSTICS:A brief AFAST scan was performed to screen for abdominal fluid, given the history of weight gain and change in resting posture. No free fluid was visualised.ASSESSMENT:  The patient presented for a progress check regarding her known congestive heart failure and recent behavioural changes. On examination, her cardiorespiratory status is stable with clear lung sounds and good pulses. Her weight has increased by approximately 1kg since September, which the owner attributes to dietary indiscretion. Abdominal palpation was difficult due to guarding, but an AFAST scan did not reveal any free fluid to account for the weight gain. The behavioural changes may be related to grief following the loss of their other dog. The "rattling" felt by the owner is not evident on auscultation today and may have been transient. Overall, she appears clinically stable despite her significant underlying cardiac disease.TREATMENT:  - Dispensed further supply of Vetmedin - Administered BB oral as was overdue  vaccine for kennel cough.PLAN:- Continue frusemide at a dose of 1/4 tablet once daily. The owner can increase to 1/2 tablet if the resting respiratory rate increases, but the lower dose is preferred for long-term management to avoid tolerance.- Monitor resting respiratory rate at home.- Re-evaluate if any signs of decompensation occur, such as coughing, increased respiratory effort, exercise intolerance, or lethargy.- Home into owner's care.CLIENT COMMUNICATION:Discussed the examination findings, which are reassuringly stable. Advised that the behavioural changes may well be related to the passing of their other dog. Discussed the prognosis for congestive heart failure; while the initial prognosis was guarded, many dogs can remain stable for some time. The need to significantly increase diuretic dosages would be a sign of disease progression. Advised to continue monitoring quality of life and resting respiratory rate. Recommended updating the kennel cough vaccination, as a respiratory infection would be a significant risk. The owner consented and the vaccine was administered. Advised to continue current medications and diet, and to return for review as needed.Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:--- 12/03/2026 09:00:10 AM HEK:Vaccinations - Resolved -    Vital Signs    Weight: 7.8;       HeartRate: 132;