C09977606 / invoice 10000

a) revisitb)c) Were the client details checked? 4cyte, galliprant, vetmedinCurrent medication & dose:------------------------------------------GapOnlyWhat is the issue?Where is the issue?When did it start?Is this a pre-existing condition according to the client?What is the next step?_____________________________History:OR significantly happier and more energetic, like how he was 2y ago. SRR great, avg 10-14bpm at home when resting.Stopped frusemide few days ago, no issues.EDUF normal no CSVD.Next plan to work on dentalExamination:Eyes bilat SNSEars clearSkin/coat ~1cm wide based lump on rump near tail base, appearance consistent with cystDental grade 4/4 in remaining teeth, marked PD and gum recessionMM CRT <2secLNs WNLHeart g4-5/6 HM HR 130, initially intermittent skipped beat vs sinus arrhythmia, then afterwards regular as became nervous and started pantingLungs WNL BV soundsAbdo comfortable NSFMSK reduced ROM both hips, reduced mass, gait stiff but energetic and jumpingNeuro NSFWeight/BCS 4-5/9Rectal n/aAssessment: MMVD stable, clinically well SRR 10-14bpmPossible intermittently irregular vs sinus arrhythmiaOngoing OASevere PD 4/4 in remaining teethPlan:1. recomm dental when able, O expressed would like to rest a bit after his ordeal2. monitoring arrhythmia at next revisit +/- ECG if persistent3. ongoing OA management re mod exercise, continue 4cyte and galliprantFollow up/reminders 4w re dental

STO re echo results good- heart progressed but blood pressure goodO really happy Wicket is back to his normal selflets try wean off frusemide- reduce from 20mg BID to SID for 4 days then stopKeep on hand incase needed in the futurePLAN tx trial of galliprant still recommendedRv in 3-4 weeks for mobility & heart check as screening/health check to book dental

Thanks for the query. At the moment sildenafil is not indicated. There are a couple of measurements we used to determine if it is required with the main one being the tricuspid valve regurgitation velocity being greater than 3.3 m/s.Warm regards,Clint Yudelman