C10019540 / invoice 10000

Follow up Call: UNWELL YESTERDAY

- O said he is still quite flat - maybe a slight improvement since yesterday but not a lot
- He ate some food last night and this mroning - seems more interested in some food
- A little sluggish today
- He felt hot last night - O hasn't felt him today
- Coming out around the house a bit more - he had been hiding yesterday
- O gave him pred this morning

- Booked in tomorrow for recheck with Dr. Jenni
- Offered apt for today but O declined - will monitor him throughout the day and will book in later this afternoon if worried

Reason: UNWELL & ANOREXIC

History:
Onset Saturday (3 days prior): reduced food intake noted Saturday morning, with episodes after eating of coughing/heaving and regurgitation-like noises as if trying to expel something; appears nauseated and waits as if to vomit but does not.
Possible small volume vomiting occurred since onset; liquid residue noted on carpet but identity of cat uncertain.

Diet history around onset: primarily hypoallergenic diets (e.g., Hill's z/d). Recently added Royal Canin Sensitivity Control chicken pouches; sometimes not enjoyed. Venison offered approximately 3-4 times over recent months, including possibly a small amount on Saturday morning.

Previous gastrointestinal history includes gastrointestinal sensitivity; prior significant illness associated with low serum protein levels.
Prednisolone course recently completed about 1 week ago; owners hoped to avoid dependence. Current signs began after discontinuation.

Owner reports drinking and urination observed. Defecation likely but not directly confirmed.

Any other concerns: Owner perceives Ping feels warm compared to the other cat.
On any medication: Prednisolone previously administered; course finished approximately 1 week prior to visit. No current medications reported.
Changes in behaviour: Markedly lethargic and seeking isolation in a quiet room for hours since Saturday.
Changes in eating/drinking: Hyporexia since Saturday; sometimes only a mouthful then walks away. Occasional gagging/heaving sounds after eating. Drinking observed.
Changes in activity levels: Marked lethargy since Saturday.
Changes in toileting: Urination observed. Defecation not directly observed but presumed. Possible small vomit noted as a liquid stain on carpet.
No change in stool consistency noted

Primarily hypoallergenic diets including Hill's z/d wet and dry. 
Recently added Royal Canin Sensitivity Control chicken pouches. 
Venison offered infrequently (approximately 3-4 times over recent months), including a small amount possibly on Saturday morning.

Physical Examination:
Temperature - 39.8
Pulse - 140
Respiratory Rate - wnl
Blood Pressure - 
Body Condition Score /9 - weight loss since last visit - 200gm
Dental Grade - 

Thoracic auscultation - no audible murmur
Reactive to laryngeal palpation
Abdominal palpation - no palpable changes
Eyes - NAD
Ears - NAD
Oral Cavity - NAD
H/Lymph - NAD
Skin - NAD
Musculoskeletal - NAD
Urogenital - NAD
Neurological - NAD
Pain Score (/10) - 

Routine Investigations:
Haematology: CBC recommended and approved to investigate fever and prior hypoproteinemia history; results pending.
Biochemistry: Serum biochemistry recommended and approved with focus on total protein/albumin; results pending.

Assessment:
Febrile illness with hyporexia, nausea, and retching: 
1) Relapse of inflammatory gastrointestinal disease after cessation of prednisolone, given timing post-taper and history of GI sensitivity. 
2) Adverse food reaction, possibly triggered by venison exposure near onset. 
3) Infectious/inflammatory process given fever of 39.8°C, warranting bloodwork to assess systemic inflammation and protein levels. 
Less likely but considered: esophagitis secondary to gastroesophageal reflux causing gagging without emesis.

Plan:
Admit for Bloods - Feline abdominal profile
+/- cerenia

LAB RESULTS  (WF)
profile normal apart from stress picture (low lymphs & eosins)

PLAN Go back on pred & hypoallergenic diet
cerenia today

RRR
 - RV with QLD on Thursday to recheck temperature