C09982683 / invoice 10000

Appointment Notes: Overdue reminders--- 01/03/2026 08:14:53 CN:Has been coughing overnight - once had some blood tinged liquid, no blood clots or thicker material.O thinks sounds more liquid in the chest compared to the day before since stopped doxycyclineNot eating this morning, O is extremely worried.Discussed optionsAdvised can send off radiographs for specialist review - O has opted for stat report. Restart doxycline - O still has tabletsRestart codeine - no tablets in stock,  written script for O.Await telemed reportScript written:Codeine 30mg x 20 tabletsPlease give one tablet every 8 - 12 hours As needed for coughing.--- 01/03/2026 12:52:14 CN:TELEMEDICINE  CONCLUSIONS:- Moderate, primarily right-sided, ventrally distributed unstructured interstitial to alveolar pulmonary pattern, raisingconcerns for bronchopneumonia and/or hemorrhage given the reported hemoptysis and anemia. An underlyingneoplastic process due to the presence of border effaced pulmonary nodules may also be possible.- The moderate bronchial pattern may be associated with the noted etiologies above or could also be exacerbated by theradiographic technique and/or presence of age associated bronchial mineralization/fibrosis.- Prominent right-sided pleural fissures, representing scant effusion, fibrosis and/for tangential beam artifacts.- Mild evidence of aerophagia.- Chronic left 7th through 10th rib fractures.RECOMMENDATIONS: For a more sensitive evaluation of the lungs, especially to screen for neoplasia, computedtomography of the thorax is recommended. Additionally, endoscopic evaluation of the trachea and bronchi with lowerairway sampling is advised to help guide management recommendations.--- 01/03/2026 13:54:12 CN:CN spoke to Diana when came in to pick up script - discussed briefly results, only discussed important components of next steps CT scan and scope - O is very overwhelmed so did not go through in detail. O is keen to proceed to next stepsOkay for SASH referral, Advised 8 - 9k estimate for initial stabilisation and work up but have advised SASH will be able to provide more acurate estimate once they have assessed Tara. On call, O advises that Tara has has coughed up more blood today so have advised to go in through emergency and then internal transfer. O will call insurance to check if will be covered.--- 02/03/2026 08:22:58 MOL:SASH patient history attached-vet to review.--- 02/03/2026 15:03:00 BML:Assessment:Tara presented this evening for tachypnoea/dyspnoea that has been worsening today and presence of heamoptysis that has startedtoday. She has had previous work up at her regular vet which should a diffuse bronchial-interstitial pattern mostly affected the RHS ofher lungs and the cranioventral lung fields on the Left. There was also noted to have possible nodules present in the lung fields.Her cough has progressed over the last 8 weeks to a dry hacking cough and progressively got worse and became a wet cough that thenbrought up blood. There is concern about a neoplastic involvement given the presence of nodules both in the lungs and the possiblemass observed on POCUS within the heart. The most likely neoplasia would be a hemangiosarcoma, however other ddx can includelymphoma, or suspected infectious causes of bronchopneumonia. Advanced imaging would be needed to differentiate the causes.She has a known anemia and azotemia noted on her previous blood test at her regular vet, but was noted to be thrombocytopenia ather regular vet before she was sedated for radiographs. She has bruising at previous injection sites and has been swelling up andbruising at veins she was injected in tonight. Given this progression there is concern about DIC, especially given her history and thesuspicion for neoplastic involvement.Overall Tara has deteriorated after admission to hospital and prognosis is now considered quite guarded.Recommendation:Initial recommendation: admit for ECC stabilisation, overnight monitoring and supportive care, Internal Med referraltomorrow AM and CT scan of chest and abdomen - Os agreed to thisAwait further comms--- 04/03/2026 09:29:12 LOC: ap Passed away at sashFlowers and card organised    Vital Signs