C09982778 / invoice 10000

Reason: GHC And Bloods CP Only NL Appointment Notes: Overdue remindersAttendees: female oHistory:Still hacking with drinking- 90% of the time20% of the time will bring up a bit of waterOnly over time he does it- potential overexerting- jumpingSteroids not helped at all- still eod to goCoughing at night and funny breathing at night still ongoingEating drinking urinating defaecating normallyNo lameness, stiffness or sorenessNo itching and scratchingBright Alert ResponsiveBody condition score 4.5Examination:Mucous membranes – pink moist crt <2sOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade 1-2Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – no discharge, no erythema, pinna fineLymph nodes - normalHeart – normal regular rhythm no pulse deficits, no murmur HR wnlLungs – clear sounds bilaterally, no crackles or wheeze, tracheal pinch negativeAbdomen – comfortable on palpation, bladder normal, no masses palpatedLimbs – all good range of movement, no swelling or pain on palpationNeck and spine – no pain on palpationSkin – no sign of erythema, no alopecia,  Nails – fineAnal glands – not scootingTemperature – wnlGenital region - no masses or swellingsAssessment:Hacking/ coughing after drinking- improved overall panting but still sometimes at night. Exercise exacerbated hacking- ddx tracheal collapse, elongated soft palate, oral mass- openALT elevation (mild), urea wnl today but elevated crea (previously normal USG- consider recheck in future,) H alb- dehydration v artefact. Has diagnosed liver mass (likely non neoplastic) when last had CT- unsure if causing ongoing elevated ALT- discussed repeat USDiscussed hacking- can consider sedated exam of back of throat to R/O elongated soft palate, mass etcAlso discussed re-transfer back to specialist for management for recheck of liver mass etc as option for owner- o overwhelmed with information in consult today- will send report summary of todays consult so O can decide on plan going forward. Also advised as some clinical improvement on hacking- can just monitor QOL going forward and also consider liver support herbal drops and recheck ALT in 1m- discontinue all pred Treatment:Nil in consPlan: Send report of consult to O    Vital Signs    Weight: 6.3;       MMColour: Pink;       RespirationRate: 33;       HeartRate: 112;       Temperature: 38.2;       BodyScore: 5;       DentalGrade: 2;       PainScore: 0;       CRT: < 1 sec;