C10029243 / invoice 10000

History;
Vader presented today for vomiting/regurgitation and inappetance that has been ongoing for 2 days. Drinking lots of water. Very flat, dull and depressed as well. 
Diet: raw food diet, no bones, no recent changes in diet
Not seen vader defecate. Urinated this morning. 
UTD with flea and worming- purchased from Woolworths. O can't remember whether all wormer or just heartwormer
No known access to toxins or rat bait. 

Clinical Examination;
Demeanor(QAR) FAS level (0)
Eyes(nad, visual, no epiphora or blepharospasm)
EARS(nad)
ORAL EXAM;(ptyalism) MM(pink and moist) CRT (2 secs)                           
HR/Pulse(120, no heart murmur)
RR & Qual(no wheezing or crackling, normal respiratory effort)
Lymph nodes(wnl)
Abdo palp (soft and comfortable, not many faeces, no obvious FBs in caudal abdomen, very mild painful response)
Skin & coat(mild skin tent) 
Muscle quality/BCS (4/9)
Joints(nad)
Rectal; semi firm faeces, slightly lipemic.

Problem list 
- Vomiting/regurgitation - ddx. foreign body (oesophageal), oesophagitis/GERD, megaoesophagus, infectious, neoplastic, gastroenteritis, vs. extra GI (renal disease, liver disease, pancreatitis, endocrinopathy - addisons vs other). 
- Ptyalism 

Recommendations;
- Option 1 (gold standard) - diagnostics for further investigation - initially bloodwork, followed by radiographs. Hospitalisation recommended for IVFT - refer to Melbourne for 24 hour monitoring over the weekend. +/- additonal diagnostics or workup based on results. 
- Option 2 - blood work for further investigation. Hospitalisation at BVC - advised unable to provide 24/7 monitoring as not staffed overnight, therefore would only be on fluids and would be unable to know how vader is progressing. 


Diagnostic tests;()

Recommendations;
- (admit for fluid bolus, rads, transfer to Bundoora- declined
- (admit for ivft and hosp o/n - O declined)
- (iv bolus, maropetent and conservative care from home, to go to hospital if vomiting after maropitent.- O accepted)


DD;()

Prognosis; ()


Treatment; ()

Plan; ()

History; 
Vader has a hx of left eye ulcer. Managed previously with tricin.  

Current medications; (Tricin)

Clinical Examination;
Demeanor(BAR)    FAS level (1, requires multiple people to restrain for eye examination)
Eyes (visual, no epiphora, L eye - scar tissue visible around site of previous ulcer, otherwise nad)

Diagnostics 
- Flourescein stain - L eye - no uptake of stain. Ulcer has healed. 

Treatment: 
- Alcaine (local anaesthetic) applied for examination 
- Maxidex (steroids) - for management of the scar tissue around the ulcer site. O advised to stop use immediately if ulcer redevelops, vader becomes painful (discharge, squinting) and contact the clinic. 


       

Virtual Vet Nurse Appointment
Cyst protruding out eye

History;
ulcer had settled, this morning O noticed a cyct? in eye
is compliant to treat at home 

Clinical Examination;
Demeanor(BAR)       FAS level (1- does take 3 peolpe to restrain )



Clinical; 
Is pet visual/non visual? ( visual) 
PLR(ok )
Duration, unilateral/ Bilateral  (unilateral  ) 
Eyelid appearance & function (ok ) 
Ectopic cilia (nil observed nil dystichia ) 
Epiphora (- ) 
Blepharospasm(no or minimal ) 
Corneal appearance (see below ) 
Conjunctiva (okl ) 
Tonometry (ne ) 


Examination with local anesthesia;
Fluorescein; ( stain uptake , some opacity of cornea locally, red flare along limbal edge  some pigmentation developing along lateral edge. ) 

DDx; 
( )

Recommendations;
( watch;, proceed to emergency if worsening rapidly. consider second op w opthalmologist )

Treatment;  
Topical; (tricin  ) 
Systemic; (- )

Prognosis;
(fair  ) 

Review due; (review in one week, if no improvemnts may need specialist opinion )