C09978747 / invoice 10000

RS - recheck, repeat bloods

History:
On clav-difficult to administer but managing. On mirtazapine transdermal once daily for appetite stimulation. Eating much better but still reduced appetite compared to normal. No vomiting. Soft stool this morning, large volume but not liquid. Drinking same. 

DEMEANOR: QAR, very frightened
TEMP: 38.4
HR/PULSE: WNLs, no murmur auscultated in the consult room today QUAL: normal
RR/EFFORT/THORACIC AUSC: wnls, chest clear, normal effort
MM: pink
CRT: instant
Ears/eyes: nad
LN: wnls
ABDO PALP: nad, tense but comfortable
MSK: nad, full msk exam not performed today
INTEG: nad
NEURO: neuro exam not performed today
BCS: 7/9

Vacc Hx: Due for vaccination - holding off due to current inflammatory process. Revolution can be applied.

Assessment/problem list:
Progressing well clinically-bloods today to re-assess liver enzymes
Will need dental once well enough
Move vacc a few months later-edited reminder

Treatment:
Blood test - comprehensive panel. 
More mirtazapine transdermal dispensed. 
Likely to need to continue antibiotics - 4 weeks total, recheck bloods after stopping. Consider compounding antibiotic to stronger concentration with flavouring. 
Consider liver biopsies vs adding steroid to current treatment depending on blood results.

Plan:
Move antibiotic dosing to 6:30am and 6:30pm with food to make easier for Os timing wise.
Continue mirtazapine. 
Revolution can be applied as is due. 
Vaccination postponed until approximately one month after fully recovered. 
Dental follow-up may proceed in 1-2 weeks depending on progress; if steroids required for liver, prefer to wait until lower dose due to immunosuppression. 
Will call with blood results this afternoon.