C10027137 / invoice 10000

HISTORYPresenting for: 5 year old female dog presented for diarrhoea with mucus since yesterday, with a history of soft stool previously.Historical Conditions: Anxiety requiring medicationDiet: Appetite normalDrinking/Urination: Drinking less than usual, possibly due to stress from construction noiseV/D/C/S: Diarrhoea started yesterday morning. Watery with mucus last night. This morning had solid stool with mucus, followed by small chunk with mucus, then just mucus. Previously had soft but formed stool. Had a gagging episode with minor vomiting prior to diarrhoea onset.Gagging/vomiting has resolved.Current Meds: Fluoxetine 5mg every 3 days (last dose was Tuesday, 3 days before Thursday). Trazodone for emergencies. Previously tried another anxiety medication that caused hyperanxiety.Lifestyle Risk Factors: Indoor dog. No contact with other dogs. Construction workers at house yesterday and today.Other: - Builders working at house may be contributing to stress- Heat may be a factor- Had diarrhoea Monday morning as wellEXAMMentation: BARWt:6.0BCS: T: Normal...forgot to record.HR:140R:normalMM:pinkHydration: NormalBehavioural: Anxious during examination. High alert. Eyes: NormalEars: Normal. No discharge, inflammation or infection noted.Nose: NormalThroat: NormalOral: Moderate tartar and minimal gingivitis.Cardiovascular: Heart sounds good, no murmurRespiratory: NormalAbdominal: Abdomen palpated, no tenderness noted. Less tense than previous exam.Lymph Nodes: NormalIntegumentary: Normal. One nail cracked, caught in blanket.Neurologic: NormalMusculoskeletal: NormalUrogenital: NormalRectal: NormalASSESSMENTColitis - Likely stress-induced from construction noise and environmental changesAnxiety - Chronic condition requiring ongoing management. Fluoxetine every 3 days is likely to be ineffective.Cracked nailPLANNew Meds/Tx:- Probiotic supplement recommended. Discussed options including FortiFlora sachets to be mixed with food daily for 1 week to help restore normal gut flora.- Nail trim performed to address cracked nailChanges to Existing Meds/Tx:- Fluoxetine frequency to be increased from every 3 days to every 2 days to better manage anxiety, especially with upcoming boarding situation-Written script for 5mg caps from compounding pharmacy of owners choice.Additional Discussion:- Discussed that colitis with mucus in stool likely stress-related from construction and environmental factors- Probiotic preferred over binding agents as patient has history of constipation with binding agents- Recommended continuing probiotics for approximately one week, then can be given as needed or once weekly for maintenance- Discussed that patient will be left with dog sitter for 2 nights soon - first time being left overnightClient Comms:- Prescription for Fluoxetine provided- Follow up if diarrhoea persists or worsens

**HISTORY****Presenting Complaint**: Gagging episodes- Episodes of gagging occurring intermittently throughout the day today - Vomited some white liquid after gagging episode- Excessive lip licking & swallowing notedEEDDU: all wnl Parasite Prevention: UTD Meds: Fluoxetine 5mg capsule every 3rd day (last given 2 days ago)C-/S-/D-/**PHYSICAL EXAMINATION**Mentation: BAR, very scared, growls with owner. Better away from ownerVitals: NADEENT: NADCARDIAC: WNLRESP: NAD, nil sensitivity on tracheal palpationSKIN: NAD**ABD. PALP: Tense on palpationLN: NAD**DIAGNOSTICS**1. In House CBC/Chem15/Lytes/PancMild - moderate polycythemia & reticulocytosis --> (splenic contraction / excitement/stress most likely)**ASSESSMENT**DDX: URT infx (eg. KC) VS GIT (eg. reflux)**TREATMENT**Maropitant 0.6ml given SQ**COMMUNICATION**- Discussed physical examination findings, differentials/assessment & plan- Discussed possibility of KC. Owner adamant not coughing and not KC. - Discussed weight management and need to reduce food intake**PLAN**- START Losec 10mg x 1/2 tab PO BID for 4 days- Re-check: Wednesday (existing appointment)- INI consider: Consider AUS vs Doxycycline trial (incase KC)JR

clipped nailsgrowled but well behavedurinated