C10024937 / invoice 10000

NURSE: LH

REASON: recheck stomach ulcers

HISTORY:
- Lethargy and reluctance to walk for 2/52.
- Still energetic when playing ball.
- Sniffing at tail, tail down a lot.
- Spooked by flies, tail down, goes outside and won't come back in.
- Partner concerned as he is off and won't walk.
- Had to be carried on a 3km walk.
- Started a few weeks ago.
- No changes to meds or home environment 2/52 ago.
- Peeing normally.
- Did not eat breakfast this morning, which is unusual.
- On Prime 100 chicken roll for 2/52, eating well.
- Also given a little bit of wet food to entice him.
- No missed medications.
- Sleeping better at night, not getting up as much.
- Poos are normal colour, 2-3 per day, not runny but not solid. Previously 5-6 per day.
- No vomiting.
- Has been scratching a bit.
- Has been doing the "prayer position" on and off.
- Hesitant on stairs.
- A new fence was built near the school where he likes to go, which may be a factor.

APPETITE: Good, eating well on new diet for 2/52. Did not eat breakfast this morning.
ACTIVITY: Lethargic, reluctant to walk. Still energetic when playing ball.
DIET: Prime 100 chicken roll, 3 times a day. Also some wet food.
TOILETING: Poos 2-3 per day, not runny but not solid. Normal colour.
CURRENT MEDICATIONS: On famotidine and carafate for stomach ulcers. Also on Apoquel for skin allergies.

**CLINICIAL EXAM:**
- Mentation: BAR
- MM: Pink
- CRT: <1 second
- Oral and Dental Score: Grade 0 dental disease.
- Eyes: Clear and bright.
- Ears: Not assessed
- BCS: 3/5
- Lumps: Not assessed
- Abdominal: No evidence of nausea or retching. No pain on palpation.
- Lymph nodes: NAD.
- HR: 114 bpm, no murmurs or arrhythmia.
- RR: Not assessed
- Temp: Not assessed
- Urogenital: Not assessed
- MSK: Not assessed
- Skin: Significant underlying skin allergies, controlled with Apoquel.

**ASSESSMENT:**
- Responding well to treatment for stomach ulcers.
- Anal glands not excessively full but some material present.
- Significant allergic skin disease, well-controlled with Apoquel.
- Possible behavioural issues (phobias, OCD-type behaviour) noted but low priority.

DISCUSSION:
- Discussed progress with stomach ulcer treatment.
- Explained anal glands can be a background issue and to monitor for signs of discomfort.
- Reiterated Apoquel is a lifelong medication for skin allergies.
- Discussed plan for stomach ulcers: treat for 1/12, then repeat ultrasound.
- If ulcers have resolved, may trial off carafate.
- If ulcers persist, may require endoscopy and biopsies.
- Discussed behavioural observations (fly phobia, reluctance to walk) and agreed to address physical issues first.

TREATMENT:
- Anal glands expressed.
- Continue current medications: famotidine, carafate, Apoquel.
- Continue feeding Prime 100 chicken roll as desired.

PLAN:
- Repeat abdominal ultrasound in 2-3 to assess stomach ulcers.
- If ulcers resolved, may trial withdrawing carafate.
- If ulcers persist, consider endoscopy and biopsies.
- Monitor for signs of anal gland discomfort.
- Consider behavioural consult in the future if needed.