C10019930 / invoice 10000

10/03/2026 [BH] Standard Appointment
Weight (Kg):4.55
History:Presenting complaint
Recheck for vomiting and weight loss. Owner now reports new onset of diarrhea.

History
- Previously seen on February 28, 2026, for thyroid check, vomiting, and weight loss.
- A novel protein diet was recommended at the last visit.
- Owner reports difficulty transitioning to the new diet.
- Diarrhea began after the last appointment; described as watery with mucus.
- Vomiting occurs after eating dry food.
- Appetite was decreased over the weekend but has since improved.
- Energy level was low but is now improving.
- Last defecation was diarrhea on March 8, 2026; no stool produced since.
- Received Gabapentin approximately one hour prior to appointment.

PEx:
BCS: 4/9
BAR
MM PM, CRT <2
HR: 2/6 heart murmur, no arrythymia
Resp: normal bronchovesicular sounds, eupneic
Oral: Grade 2-3/4 dental disease. Significant calculus on upper arcade. Gingivitis noted. Missing upper canine.
Eyes: dilated pupils
Ear: no discharge, no erythema
Integ: no erythema
LN: within normal limits
Abdo: soft, comfortable. Small, hard feces palpated.
Other: Palpable enlarged thyroid slip.

Diagnostics:
Radiographs taken without sedation
Large distended colon with moderate sized fecal ball in the distal colon
Distended stomach and gas distended loops of small intestine
Displaced intestines to the right on VD
Kidneys appear irregular and hazy

Assessment
Concern for IBD, neoplasia, ilius, gastroenteritis, obstruction etc

Treatment
Cerenia 16mg tablets dispensed, 3/4 tablet PO once daily
Osmolax (client has at home)

Client communication
- Radiograph findings were discussed.
- Showed owner the significant gas in the stomach and colon.
- Pointed out the displacement of intestines, raising concern for an underlying mass or fluid.
- Recommended an abdominal ultrasound for further diagnostics.
- An estimate for a sedated ultrasound was provided (~$700).
- Discussed the possibility of attempting the ultrasound without sedation.
- Recommended increasing the pre-visit Gabapentin dose to 1.5 capsules for the ultrasound procedure.
- Discussed the option of sending radiographs for specialist interpretation ($290) --> declined
- Discussed a potentially poor prognosis if a large mass is confirmed.
- Palliative care options were reviewed, including steroids, anti-nausea medication, and appetite stimulants.
- Cerenia was prescribed for nausea.

Plan
Book in for U/S with RB

BH