C10028472 / invoice 10000

**
HOSPITAL NOTES - MORNING

VET: TZ                                                                                
NURSE: RT

AES SUMMARY:
- Presenting for diarrhoea which started 11/03 evening 
- Had surgery for right-sided elbow OCD last Wednesday (04/03/2026).
- The diarrhoea was a single episode of a large amount. No blood or mucus was noted.
- No vomiting.
- Had been drooling 11/03.
- Bowel movements were normal at 8:30 am, then no movement until 4:00 pm.
- A fentanyl patch was removed yesterday, which had caused an allergic reaction
treated with flumazine cream.
- Medications: Meloxicam (last dose at 4:00 pm today, has been on it for approx. 4
weeks pre- and post-op), pregabalin, trazodone, flamazine
- Allergies: Allergic reaction to fentanyl patch.

CLINICAL EXAMINATION
MENTATION    - Nervous, alert, responsive 
MM                    - Pink, moist 
CRT                  - <2s
HR                    - 120bpm clear 
RR                    -  Panting 
TEMP               - 39.2
WEIGHT          - 31.5kg

TREATMENT:
Maropitant 1mg/kg IV q24hr, last given 11/3 @ 2000
Pro-kolin paste 5mL given at midnight
IVFT 90ml/hr ongoing 
Pregabalin 75mg PO @ 9:50am 
Trazodone 150mg PO @ 9:50am 

ASSESSMENT:
D+ 
Stable

Owners Contacted   - Y, wanting to stay in hospital today until D+ resolves
Updated with bill       - Y 

MEDICATIONS DUE:
Maropitant @ 8pm
Pro-kolin @ 12pm 

PLAN:
Hospitalisation and supportive care throughout the day, plan to discharge this afternoon
O bringing in trazodone and pregabalin 
Offer gastrointestinal food 
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HOSPITAL NOTES - AFTERNOON

VET:  TZ                                                                               
NURSE:

CLINICAL EXAMINATION 2:40pm
MENTATION  - QAR/Flat, mild hypersalivation 
MM                  - Pink, moist 
CRT                - 2s 
HR                   - 72bpm
RR                   - 28bpm
Temp               - 37.4

TREATMENT:
Pro-kolin 5ml PO @ 12:35pm
Ondansetron 0.5mg/kg IV @ 2:45pm

Millie seems flatter this afternoon and is now refusing food
She has developed haemorrhagic diarrhoea ++
Likely AHDS, although can do abdominal US to rule out gastric ulceration - Ox keen

ABDOMINAL ULTRASOUND 
Liver/biliary system – NAD
Kidneys – NAD
Adrenals - both approx 4mm
Spleen - NAD
Pancreas - no obvious abnormality noted
GIT – No focal or diffuse wall thickening noted and no obstructive pattern seen. LI fluid filled at
time of scan
Bladder/pelvic area - No obvious abnormality noted. No focal or diffuse wall thickening noted
and no intraluminal problem seen
LN/great vessels - no obvious abnormality noted

Assessment
LI changes consistent with colitis - otherwise normal abdominal ultrasound based on today’s scan

DISCUSSION:
- discussed colitis on ultrasound, continue treating as AHDS
- Ox wants AES again overnight with ongoing supportive treatment, with likely discharge tomorrow AM

PATIENT DAY SUMMARY:
Today Millie became flatter and more nauseous in hospital. She developed haemorrhagic diarrhoea, and an abdominal ultrasound which only showed evidence of colitis.
Her owner would like continued supportive treatment overnight with transfer back to TVH-M in the AM. 

ASSESSMENT:
Acute hemorrhagic diarrhoea syndrome 

Pet Transport - Y
Owners Contacted   - Y
Updated with bill       - Y

VETCHECK LINK TO HOSPITAL CHART:
https://plugin.vetcheck.it/vetform?action=chart&id=6272&shared_id=2118302&hash=AU_afaecb2c-7fbf-43ea-9173-ab78afc1a73a&content_type=form&redirect=home%3Fmenu%3Dactive%26filter%3Dall

PLAN:
Transfer to AES for ongoing supportive care, IVFT and medication administration (ondansetron, pro-kolin, maropitant) 
Return to TVH-M tomorrow AM for likely discharge 

**
REHABILITATION 

NURSE: ZB 

REFERRING VET HISTORY:
Diagnosis: OCD lesion RF Elbow. 
Concerns: ongoing recovery and long term management. 

HISTORY:
Initially presented with forelimb lameness. 
CT scan performed after finding discomfort on elbow pronation. 
CT scan showed OCD of right humeral trochlea, with minimal secondary right degenerative joint disease and panosteitis of the right radius. 
Elbow Arthroscopy performed 1 week ago, OCD lesion removed off R medial humeral condyle. 
Since last week Brooke reports that Millie has been recovering well from her procedure with no signs of discomfort. 
She is able to rise and lay down with no pain indicated. 
Going outside for toilet walks only, and then confined to a crate for remainder of time. 

REHAB EXAMINATION:
MSK:
- forelimb, comfortable on palpation of musculature and joint ROM. 
Muscle atrophy to RF compared to LF. 
- hind limb, comfortable on palpitation of musculature and joint ROM.  

approx. 70 degree flexion on LF elbow, 170 degrees extension (normal range 36 degrees and 166 degrees) 
Muscle circumference 22cm on RF, 24 on LF. 
21cm on RF  and 23cm on LF when laying down. 

PROBLEM LIST:
- muscle wastage 
- reduced ROM and function in RF 

GOALS:
Improve RF function. 
Increase muscle mass. 
Increase ROM. 
Maintain/improve mobility long term. 

REHAB PLAN & TIME FRAME:
1. Slow leash walks - 5 mins working up to 10 mins over the next 4 weeks. 
2. ROM elbow RF 10-15 reps SID-BID 
3. Cookie Crunches 8-10 reps each side. SID-BID.
4. Stand to lay 8-10 reps SID-BID. 
5. Hydrotherapy 
 
REVISITS: 
Recommend Hydrotherapy. 
Will send Brooke information regarding this and she will see if this is something that can be achieved. 
If not able to, then RV with GHS/JS at 4 week mark for reassessment and make call then if further rehabilitation appointments required/manageable for Brooke. 

*
NURSE: CPC

REASON: Fentanyl patch removal 

HISTORY:
- Going well at home, has yelped when trying to squat to go to the toilet but otherwsie well 
- Not irritated by the bandage at all

EDDU: Normally 

Current Medications: Pregabalin 1 capsule BID, Trazodone 1 tablet BID 

ASSESSMENT:
- Fentanyl patch removed 
- On removal noticed significant reaction, significant redness present 

PLAN:
- Surgical revisit in 4 days with GHS
- Dispensed neocort to be applied to the area BID 
- Monitor for excessive licking, chewing, scratching at the area where the patch was removed.