C10027873 / invoice 10000

ate a 2-3cm kangaroo treat with a hepatoadvance tablet yesterday. at same time started barking and then was choking, gagging/retching. couldnt lie down. did not go purple/blue. went to currumbin. 1 lateral xray of neck done. soft tissue opacity in oesophagus distal to larynx. given metacam liquid and 1/2 anti-histamine last night. told to feed soft food.had 2 small drinks last night.ate some soft food. no clinical signs when eating or drinking. no regurgitation. swallowing a lot.wheezing/reverse sneezing. wont lie on his side. when he does relax he wheezes and reverse sneezes. when he finally slept he was snoring really bad which is not normal. current meds: metacam last night, antihistamine last night. on trilostane. usually gives in morning but not given this morninghepatoadvance CBD oil no vomitingno diarrhoea. passed normal feces this morningurinating normally. went this morningnot drinking this morningno food given this morning cx: BAR, eyes clear. ears clean. mouth - mild grade 1/4 tartar. mm pink and moist. CRT 1-2s. no oral lesionsrepeatedly swallowing but no reaction to throat palpation. stertor upper respiratory noise. heart clear. no murmur or arrthymias. HR 120bpm. femoral pulses strong and synchronouslungs clear in all fields. referred upper airway noise. abdomen soft and comfortableperipheral lymph nodes normalBCS 6/9temp 38.2diagnostics: comprehensive: albumin 46, Total calcium 3.06 (likely from dehydration/high albumin). ALT 312, ALP 726 (stable from bloods 3 months ago) --> likely from cushings disease?CBC: HCT 52%, platelets 525lateral neck xray - no obvious findings. premed: 0.02mg/kg ACP (0.09mls) + 0.2mg/kg methadone  (0.17mls) IV. induction with 2mg/kg alfaxan IV (2.1mls)6.0fr ET placed. normal mouth/larynx, proximal trachea on ET tube placement. very small abrasions on caudal tongue. oxygen/iso maintenance. flexible GI endoscopy passed into oesophagus. normal oesophagus, with no inflammation. retroflexed to look at nasopharynx. very inflammed caudal nasopharynx with hemorrhage. flushed. normal right and left choanae with no inflammation at entrances to choanae. all inflammation is caudal nasapharynx. No FB present.plan:dexamethasone 0.1mg/kg IV at 12.55pm. to do short tapering course of pred at home. (no more metacam). had one single dose last night. cushings control will be affected by prednisolone but short course. if ongoing clinical signs despite pred recommend referral to specialist for CT.  endoscopy to look at nasopharynx EXAMINATION: Demeanour: BAR MM: Pink, moist, CRT <2 Eyes: Clean and clear, normal eyelids, no erythema or discharge Ears: Minimal debris, no inflammation or odour Lymph nodes: Peripheral lymph nodes palpably normal Oral: No oral lesions or abnormalities detectedTeeth: Dental grade 0/4, normal occlusion. COHAT Level Estimated: (A, B, C, D, E) Cardiovascular: Normal heart sounds, no murmurs or arrhythmias detected, femoral pulses synchronous and normodynamic Respiratory: No nasal discharge, normal bronchovesicular lung sounds in all 4 quadrants, no coughing seen Abdomen: Soft and comfortable on palpation, no masses palpated, bladder unremarkable MSK: Normal gait no lameness. Normal ROM with no pain of all limbs. No pain on DV palpation of spine Integument: Coat is soft and clean, no ectoparasites detected, no obvious skin lesions or masses Neurological: Normal mentation, no ataxia or CP deficits observed. Full exam not performed Reproductive/Urogenital: External genitalia normal in appearance Rectal: Not performed PROBLEM LIST: N/A DIAGNOSTICS: N/A ASSESSMENT/DDX: PLAN:MEDICATION: CLIENT COMMUNICATION: N/A TREATMENT: Handouts given: Health report / Dental / Arthritis / Other (Name)Estimate provided (Y/N or NA)    Vital Signs    HeartRate: 120;       Temperature: 38.2;       Weight: 8.57;