C09972824 / invoice 10000

Reason: Going DownhillHistory-Update:HISTORY:  Presented for recheck consultation as Kiba is not doing well. The owner was awaiting a plan from the specialist at ARH (Kim) before scheduling the appointment.Was going to come for an appointment tomorrow to strat the plan given by dr. KimThe specialist at ARH has recommended a plan for suspected immune-mediated disease. This includes prednisolone at 2mg/kg for two weeks, then tapering to 1mg/kg. A second immunomodulatory medication (e.g., cyclosporine) is recommended to be started concurrently. The plan is to wean off prednisolone over 3-4 months and continue the second medication for 6-8 months. Clopidogrel is to be continued until prednisolone is ceased.(ran out Last Thursday) Current meds: Prednisolone 20mg once daily (11.8kg body weight). The owner ran out of clopidogrel last Thursday.Vaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: Suspected immune-mediated haemolytic anaemia (IMHA).Access to toxins eg. Rodenticide: none TRIAGE:HR: HyperdynamicRR: IncreasedTemp: NormalMm:  not discussedCrt: not discussedMentation: not discussedDemeanour/Behaviour: Agitated, has attempted to bite staff. EXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory:thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological:neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):not graded- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: Agitated, has attempted to bite staff. PROBLEM LIST:- Worsening of clinical signs- Anaemia (PCV 16%)- Suspected immune-mediated haemolytic anaemia (IMHA) DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Immune-mediated haemolytic anaemia (IMHA) DIAGNOSTICS:Bloods were taken for in-house testing:- Please find attached to the patient record.> Complete Blood Count- Significant findings: PCV 16%. Leukocytosis noted, likely secondary to immunosuppressive dose of prednisolone. Thrombocytopenia > Biochemistry- Significant findings: ALP and ALT elavation, likely secondary to prednisolone administration. ASSESSMENT: Kiba presented for re-evaluation due to a decline in condition. He is currently on prednisolone for suspected IMHA. Blood analysis today revealed a PCV of 16%, indicating a worsening of anaemia. The elevated ALP and high white cell count are considered likely side effects of the high-dose steroid therapy. The plan from the specialist at ARH was discussed. Further direction from ARH is required based on today's results to guide treatment, specifically regarding the potential need for another blood transfusion versus adjustment of immunosuppressive medication. TREATMENT:  Discharged home into owner's care.Current medication: Prednisolone 20mg once daily.A script for Clopidogrel will be provided after consultation with ARH. PLAN:Contact ARH to discuss current findings and determine the next steps. This may include referral back to ARH, starting additional medications, or adjusting current dosages.The owner will be contacted by phone with an updated plan.Kiba is to be sent home to minimise stress while awaiting the plan. CLIENT COMMUNICATION:Discussed the results of the in-house blood tests, specifically the low PCV of 16%. Explained that a nurse will contact ARH to provide a detailed history and get advice on the next steps, as our email system is currently down. Informed the owner that Kiba is stable but has the potential to deteriorate. The cost of the consultation and blood tests today is $287. I will call the owner with a plan once I have spoken with ARH. Sent home to reduce stress.    Vital Signs    Weight: 11.8;       HeartRate: 160;       RespirationRate: panting-60/min;       MMColour: pale MM;       Temperature: 38.2;