C09976231 / invoice 10000

Reason: Seems Not Right - MhAppointment Notes: couldnt come sooner - mhAttendees: Catherine History:Daisy presents for NQR - reduced appetite, occasional trembling and lethargy. Was discharged from hospital on 18th February following admission for tachypnoea, pyrexia and lethargy - diagnostics revealed suspected pulmonary oedema and stage C MVD. Was discharged home with doxycycline and anti-inflammatory trial to cover for potential URT - already started on diuretics and pimobenden as below:- Doxycycline 25mg BID PO - last administered 28th Febuary - Meloxicam 5kg dose SID PO - last administered 28th Febuary- Pimobendan 1.25mg BID PO - Frusemide 20mg SID PO - due to reduce to 10mg SID PO Panadol 15mg/kg PO and gabapentin 100mg POas analgesia and anxiolysis administered in hospital per records. Owner advises RR/RE has settled since starting heart medication - was doing well until the last 3-days. No known toxin exposure. UTD with F/T/W treatment. No recent travel history.  Eating drinking urinating defaecating normallyNo vomiting/retchingNo coughing, no exercise intolerance, no breathing difficultyNo lameness, stiffness or sorenessNo itching and scratchingBright Alert ResponsiveBody condition score 5/9.  Examination:Mucous membranes – pink moist crt <2sOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade 2Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – no discharge, no erythema, pinna fineLymph nodes - normalHeart – normal regular rhythm no pulse deficits, G4  LHS SA  murmur HR 72 Lungs – clear sounds bilaterally, no crackles or wheeze, tracheal pinch negativeAbdomen – comfortable on palpation, bladder normal, no masses palpatedLimbs – all good range of movement, no swelling or pain on palpationNeck and spine – no pain on palpationSkin – no sign of erythema, no alopecia,  Nails – fineTemperature – 39.1Genital region - no masses or swellingsDiagnosis:Cardiomyopathy - suspected stage CMild pyrexia Lethargy with reduced appetiteSevere hepatopathy 1607U/L ALT, 290 ALKP, GGT 24U/L, TBIL 25Umol/L, Cholesterol 11.93Moderate azotaemia and hypokalaemia (3.0mmol/L) and mild hypochloraemia (105) - likely secondary to diuretic therapy (will need furosemide dose adjustment) and reduced dietary intake Plan: Referred to VSS for acute hepatopathy - pre-existing cardiomyopathy with recent episode of pulmonary oedema.    Vital Signs    Weight: 5.5;