C09987463 / invoice 10000

Reason: Starting To Breath FasterAppointment Notes: Overdue remindersRRR40-45Verified: NoHistory:Presenting for: Patient presented for increased respiratory rate that has been worsening over the last few weeks, with intermittent episodes and increased coughing frequency.Historical Conditions:- Heart murmur previously diagnosed, graded as 3/6 on cardiac ultrasound by Damon over 6 months ago- Previous cardiac ultrasound performed in May (patient and another dog named Susie were both scanned)V/D/C/S:- Coughing has increased in frequency over recent weeks but remains non-productive- Cough is the same type as previously experienced but more frequent- Gets short of breath more easily with exertionCurrent Meds:- Cardisure (pimobendan) - current dose maintainedOther:- Respiratory rate at night during sleep counted by owner at around 40 breaths per minute- Weight has been slowly increasingExamine:Wt: Weight gain noted from previous visitHR: 140 bpm, regular rhythm, strong pulseMM: Tongue colour pale, possibly with a tint of pinkCardiovascular: Heart murmur present, increased in intensity from previous examination (previously graded 3/6)Diagnostics: Blood test performed - kidney function normal with minor reduction in some values but within acceptable range for starting diuretic therapy. Haematocrit 37.3% (normal range 36.5%), slightly on low side but not concerning unless drops to 28%.Assessment:Congestive heart failure - Worsening based on increased respiratory rate (40 bpm during sleep, normal <28), increased heart murmur intensity, pale MM, and clinical signs of exercise intolerance and increased coughing frequency.Plan:New Meds/Tx:- Frusemide 1.5 tablets morning and night (3 tablets total per day) - low starting dose for diuretic effect to drain fluid from chest. May cause increased water intake and urination, ensure water always available.Additional Discussion:- Owner to continue monitoring respiratory rate during sleep and document changes- Cardiac ultrasound to be scheduled within next 1-2 months given worsening condition- Chest radiographs may be performed at time of ultrasound to evaluate lung pattern- Weight management discussed - reduce treats and snacking to prevent further weight gainClient Comms:- Call in one week to report respiratory rate changes and response to medication- Contact clinic to schedule earlier cardiac ultrasound appointment given progression of condition- If no improvement on frusemide, return for chest radiographs and further evaluation    Vital Signs    Weight: 12.9;