C10031791 / invoice 10000

HISTORY
Presenting for: Monty presented for revisit examination following previous treatment for upper airway stridor 
WAVES thought was spinal pain, O doesn't feel this is the case (I agree)
Historical Conditions: Heart dz
V/D/C/S: Owner reports no vomiting or diarrhoea and no further coughing
Current Meds: Paracetamol, Gabapentin, Vetmedin plus from WAVES got Ondansetron wafers, Metoclopramide (5 days dispensed 9/3, finishing today)
Other: Patient has been on 6 weeks strict rest as prescribed by referring veterinarian. Owner reports Monty is becoming restless with confinement.

EXAM
HR: 120 BPM
MM: Pink and moist
Hydration: Normal skin turgor
Behavioural: Patient would not tolerate throat examination today
Throat: Unable to examine throat area 
Cardiovascular: Heart murmur present, no arrhythmia detected today
Respiratory: Mild upper airway stridor present but copiously improved compared to last visit. Lung sounds normal.
Abdominal: Soft and comfortable
Neurologic: Conscious proprioception normal on all 4 legs
Musculoskeletal: No evidence of spinal pain detected today

ASSESSMENT
Upper airway stridor - significantly improved from previous visit
Heart murmur - stable, no arrhythmia present today
Suspected eosinophilic pharyngitis - unable to assess progress due to patient intolerance of examination

PLAN
Discuss with O - I suspect that the cause of the issues was perhaps some kind of pain initially, then panting which irritated his eosinophilic pharyngitis, which caused intermittent upper airway obstruction and the lung changes noted. 
At this stage, can monitor closely, but could trial anti-histamine in case any allergic component

Changes to Existing Meds/Tx:
- Fentanyl patch removed today

Additional Discussion:
- Gradual return to activity approved: short 5-minute walks twice daily starting Monday morning (not to commence over weekend when clinic unavailable)
- Activity to be increased slowly and monitored closely
- Weight loss recommended to reduce pressure on throat
- No value in repeating blood tests at this stage, but can do if concerned
- Recheck if owner has any concerns

Client communication.

GC rang and ST MO
Reports Monty has been going well at home since discharged from WAVES, brighter demenour and breathing is going well, has been eating ok.
Small amount of D+ but owner monitoring, if concerned will call otherwise booked in for recheck w JE and r/o of fentanyl patch on saturday