C09979433 / invoice 20000

Reason: Ongoing unwell - anaemia, epistaxis, spinal painHistory: SUMMARY 14/1 - (Dr JB) Presented pain -R cervical and lumbar. Hx of slipping off curb on walk. Difficulty rising. Txed previcox - poor improvement20/1 - (Dr JB) TAHP sent Idexx21/2 (Dr JB) non sedated xrays - no significant findings. Clinical signs similar to previous presentation - no change with NSAIDLow normal PCV -  40%  Lymphopenia - - all remaining WBCs low normalLow ret haemH MCHGlobulins normal23/1 (Dr Jacqui) Increased pain symptoms - dispensed Prednisolone to replace NSAIDs24/1 sneezing epsisode and small droplets of blood - small number of incidents - did not progress or continue.25/1 Started prednisolone 20mg BID for 2 days, then 20mg SID for 5 days, then 10mg EOD. Good response to pred. Think last pred given 5/2/26.16/2 After a nearly two-week withdrawal period, painful symptoms recurred, and he was restarted on a low dose of Prednisolone (10mg every second day). This second course was complicated by diarrhoea, which resolved with a pro-kolin supplement. Last dose given 25/224/2 - SASHAM Major Epistaxis event - large blood clots.  bloods and urine performedPCV/TP-30/78PT normal 12 (11-17)APTT 112 slightly prolonged (72-102)ABLL NA 155, glucose 4.3 mild reducedCBC: normal platelet count, mild anemia pre-regenerative or non regenerativeBiochem: globulins elevated 52 (25-45) , TP elevated 84( 52-82 )- urine results?26/2 - VSS (Dr Peter Barron)CT - no bone lesions - rule out multiple myeloma?. Incidental cyst R kidneyBloodsPCV 24. Normal globulins28/2 - GX Burleigh - bloods - positive autoagglutination in house. T 39.9Idexx - Coombs test sent POSITIVE 2+ result. In house PCV 29Started pred 20mg BID - given given since sat till nowToday 3/3 - PCV/TP  24/76Examination:Demeanour - BAR - quieter than normalMms pale pink and moist. CRT 2 sec. EuhydratedHR 120 CV auscultation NAD. Pulse normodynamic and synchronousRR 28 RESP auscultation NADAbdo palpation NAD - soft and non painfulLNs NADNormothermic T 38.0Mild epistaxis RIGHT nare - briefly at 1pmLaboratory: Coombs results - POSITIVE PCV 24 TP 76Bloods sent to Idexx for repeat Haematology - yesterday sample clottedFollowing discussion with Dr Peter Barron - also sending to Idexx Protein  Electrophoresis - Serum sent to Idexx (insufficient with yesterday sample)Treatment: pred 20mg BIDPlan: following discussion with Dr Peter Barron- continue with immunosuppressive dose of pred 20mg BID- await Idexx bloods    Vital Signs    

Reason: Repeat bloods for monitoring anaemia as per Dr Peter Barron from VSS recommends. Waiting for results for Cooms test and blood smear to confirm IMHA diagnosis, inhouse testing at Burleigh waters was positive on 28.2.26. Dr Jacqui recommends more pred if results come back positive, more will need to be dispensed. Due to incidental finding on CT of mass on R kidney, lymphoma test was being considered. However, as a result of being back on pred, he's now inelligble for the test    Vital Signs    Weight: 21.8;