C09987402 / invoice 10000

CP2 results:
- low alb, high glob - inverted ratio
- mild elevation CRP 47 (<10)
- WBC and RBC wnl
- mild elevation amylase
- GGT is negative or 0 - reported as unavailable but checked with Vetnostics pathologist

Bloods show chronic active inflammation. Discussed case with Vetnostics pathologist. 
Ddx: IMPA, aspergillosis (GS breed), PLN or PLE, neoplasia, addisons (although Na/K ratio wnl), other.

Waxing/waning lethargy for past 6mo. Unlikely that R elbow arthritis is causing this lethargy as not showing obvious lameness on RFL. 
O reports initial response to beransa but not really effective recently. Minimal response to metacam - again suggests OA is less likely.
Recommend further workup - UA, joint taps, galactomannan (aspergillosis test) - o keen to pursue.
Responded well to neurontin so dispensed more for over weekend.
Will send estimate - just need to find price for polyarthritis screen with Vetnostics.

NOTE: galactomannan fresh blood sample on serum - will be increased if there is systemic aspergillosis