C09977740 / invoice 20000

bloods show multiple changes
 - all liver enzymes up (similar to results Dec 2024)
- amylase up but lipase normal (similar to previous) - more likely impaired renal clearance than true pancreatitis
- urea up (new) creat normal
- crp 38 (similar)
- TP marginal decrease
- glob marginal increase

K elevated (haemolyis vs metabolic alkalosis), but could be spurious due to sample haemolysis
reticulocytosis - ??inflammation vs cell turnover

consistent with inflammatory process - likely centred on biliary tree / liver - likely related to the masses seen on ultrasound

I suspect the inflammatory process is probably a significant underlying cause of the weight loss / poor appetite and possibly also leads to more panting and the inspiratory noise
if we were looking to go ahead with any anaesthetic I would need to document a normal K+ first

Presented for -  general check up
- concerned about harsh breathing - suspicious laryngeal paralysis - is worse when hot or stressed
- variable appetite and some weight loss
- dental 2023 - went well but was meant to go back and remove further teeth
- bloods and ultrasound dec 2024 - multiple large liver masses found - suspected malignancy - was given poor prognosis but is still doing well

Current medications: nil
Parasite control: 

Mentation: stressed, panting
EDUF:  has rotated through foods - like BARF, then went off it, liked canned food then went off it,  Liked steak for a bit, then like chicken.  Overall appetite has decreased.  Drinking a little more
Diet:  currently is getting variety - chicken etc
MM:  pink
CRT:  imm
DS: 3/4
Skin tent:  nad
LN:  nad
Ears:  nad
Eyes:  nad
Thyroid: 
HR:  140
Chest Auscultation:  panting, no obvious heart murmur or abnormal lung sounds
breath sounds are harsh over throat
unable to visualise vocal cords on consious dog
Abdo Palpation:  bit tense - but no significant findings.  Unable to palpate previously reported hepatomegaly
BCS: 4/9 is losing muscle mass
Temp: not assessed
Rectal Exam:  nad externally
Skin:  nad
Joints/Gait: nad
Urogenital:  nad
Vaccination status: not vaccinated
 
Problem list: 
1. poor appetite
2. weight loss
3. probably laryngeal paralysis
4. previous detected liver masses - suspected carcinoma at the time - clinical progress has not been consistent but follow up is warranted
5. ongoing dental disease - ideally repeat dental with extraction of teeth marked last time

Plan:  bloods taken for full profile
if no alarming changes then consider GA to check for laryngeal paralysis and finish dental (nb would need to repeat rads and still likely stage dental - potassium was rising during last procedure)

o is a pharmacist and can source mirtazapine - dose 1.1mg / kg q 24 - so 1.5x 15mg tablet
Communication: TM will call with results 

post op (dental check)
went very well after GA

has been on meloxicam / neurontin / amoxyclav

stressed and panting in waiting room
mm pink, crt imm
extraction sites healing well - the 109 / 110 is still granulating and there is some inflammation 202 area
gums look good
cant' get heart rate due to panting
Rt 38.8

plan: dental recheck in 3 months - ideally with TM
will probably schedule another dental then or in 6 months - premed with TXA orall for a few days prior to sx and trazadone anxiolytic schedule
will need to monitor potassium closely again