C10025890 / invoice 10000

Reason: V+

History:
According to hx when last seen Kora has stopped vomiting for a few months, v+ seems to be coming back again.
Yesterday morning v+ yellow bile, O has already woken up at 5:30am to give a small amount of kibble in case it is hunger induced
After lunch v+ digested and undigested kibble. Has not vomited since
Has not defecated yesterday or this morning, but previous day was firm healthy stool
Energy levels normal, not lethargic, still drinking as normal and keen for food
No change in diet - diet consists of Lyka as well as a handful of kibbles, both of which has not been altered. O prefers Lyka as there are no chemical ingredients on the list. Kora is a fast eater.
Has tried licky mats before, Kora does not typically get walked or made to exercise after meals
UTD PPV
Does like to scavenge when out, likes to eat grass or mud sometimes, never eats inedible things that O is aware of (ie rocks or cloth, toys etc)

Vital Signs:
Temperature:  38.2C
Heart Rate: 80  bpm 
Pulse rate:  80
Pulse character: strong and synchronous. 
Respiration Rate: 24 
MM:  pink, moist
CRT: <1 sec

Dehydration assessment: Euhydrated MM moist no skin tent

PHYSICAL EXAMINATION:
Appearance: BAR; BCS 6/9
Eyes: nad. no redness, discharge, blepharospasm. responds to visual stimulus
Ears: nad. no debris or inflammation
Nose: nad
Oral Cavity: nad. no gingivitis, calculus/tartar or other oral lesion 
Cardiovascular: Auscultation no murmur detected ,pulse quality normal ,rhythm regular
Respiratory: RE normal , auscultation normal
Abdomen: soft and comfortable, no pain on deeper palpation, no obvious fb palpable
Musculoskeletal: ambulatory all 4 limbs
Neurological: appropriate mentation
Integument: free of ectoparasites or other skin lesion
Peripheral LNs:Normal size, symmetrical
Urogenital: not assessed
Rectal exam: not examined

Assessment/Problem List:
1. V+ (chronic?)
DDx: indiscretion vs. dysbiosis vs. IBD vs. food sensitivity/allergy vs. extraGI/GI vs. other

Plan:
Discussed lifestyle and diet modifications
1. Slow feeder or feeding smaller but more frequent meals
2. Consider addition of fortiflora (pre and probiotics)
3. Limit activity surrounding meal times
4. Consider switching to hypoallergenic diet strictly to rule out food allergy or food responsive IBD

If no improvement despite changes recommend abdo u/s +/- repeat tahp to see if any changes from last year. 
O will try above, will try hypoallergenic last as prefers Lyka but not apposed. CI will call in 5 weeks time to check in on Kora.

Reason: vaccination 

History:
EDDU normal. was V+ 1-2 times a week now hasnt V+ for a couple months 

Vital Signs:
Temperature: C
Heart Rate: wnl  bpm 
Pulse rate:  
Pulse character: strong and synchronous. 
Respiration Rate: wnl 
MM: pm 
CRT: <2 sec

PHYSICAL EXAMINATION:
Appearance: BAR; BCS 3.5/5
Eyes: nad
Ears: nad
Nose: nad
Oral Cavity: little tartar, 107 fractured at base, root present 
Heart / Lungs:eupnoeic , no dyspnoea, normal bronchovesicular sounds
Abdomen: nad
Musculoskeletal: ambulatory 
Neurological: neuro exam not performed
Integument: nad 
Peripheral LNs: nad
Urogenital: nad
Rectal exam: not performed 

Assessment/Problem List:
fit for vaccination 

Treatment:
triennial C3, KC, C2i SC

consider bloods, food trial, ultrasound if V+ persists 

Plan:
booster in 1 year
recommended dental with extraction of remaining 107