C09984759 / invoice 10000

Student : Jasleen Bath & Zen Yeng Yeap Reason: General Health Check And DiscussionAppointment Notes: Overdue remindersReason: Panting lots (as though she had intense exercise), drooling after waking up, imbalanced gait- started last week- panting settles within 10-15minsCoughing increased at night- started in the last 2d Reverse sneezing- sporadic, few episodesClient suspects reflux (client discerned from normal v+) that happened once- clear liquid & some residual food, likely regurgitation; just 1h before 2nd round of medicationSeizure episode in Dec 2024 Cataracts worsened Pacing at night in the house, but stays still when let out. Needs 2-3 unsettled cycles at night before she can go back to sleep. Still goes on walks around the neighbourhood.History: EDDU: as usual. D+/v+: none Diet: boiled chicken & Lyca. Coughing/sneezing: Reverse sneezingConcurrent conditions:- grade B2 MMVD Current medications:- pimobendan- tapered furosemide 1/4 dose BID, only given when required (around 2x in 2 weeks) - Kappra Vax: UTDParasite control:  UTD (monthly) Examination: HR:   120bpm         RR:   panting         MM:               CRT:              FP:             temp: not takenBwt: 8.5kgBCS: 5/9LNs: not eaisly palpable, likely normal Pain score: Eyes: cloudy eyes (hx of cataracts) Resp: Possible crackles in right cranioventral lung lobes. No wheezes.Ears: clean. Oral: unable to examine due to stress.CVS: Abdominal Palpation: GIT: MSK: All 4 limbs ambulatory. No further investigation warranted.Neuro: All 4 limbs ambulatory. No further investigation warranted.Urogenital:Anal tone: Integument: Smooth clean coat.      Assessment: - Increased panting at night, drooling and imbalanced gait.Treatment: Consent has been given by the client to proceed with this treatment  -  YesFurosemide- give 1/4 tablet for a few days for 1 wkGabapentine 100mg per tablet- one tablet SID before bed, or if insufficient try one tablet BID, or two tablets SID at night. Plan:Options offered to client 1) Furosemide- given as described above to investigate if it improves coughing. 2) Gabapentine- explained that it is calming & provides pain relief which could with her sleep. She may appear drunk which is a normal effect of this drug. Can be given at night before bed. Used in the past for neurological pain & mild seizure (may improve seizure). But continue Kappra. Reassured that there aren't side effects to be concerned about. 3) Euthanasia- queried client about what to do going forward, whether they have considered this.Client concerned about slight weight loss- but this is a normal catabolic age-related effect. Client chose to continue with pain relief, happy to go with furosemide & gabapentine. Just wants LuLu to feel alright.Recommended to repeat Echocardiograph from previous visit which is due. Client advised to call for more medication which can be dispensed within 6m of this visit.    Vital Signs    Weight: 8.5kg;