C09991972 / invoice 10000

Reason: Revisit mobility

History: Has lost another 800g in just over a month. Food intake has halved. No V+ or D+. Still no PU/PD but she is wasting away and becoming weaker. Maybe breathing more rapidly at home (although always inside in air con). Still very curved to the left. Not really ataxic, just weak.  

Medications: 
1) Meloxicam 1.6mg SID
2) 4cyte epiitalis forte gel SID
3) CBD oil 20mg PO BID

Examination: 
Mentation: QAR, gorgeous girl but not her normal self. 
Body condition score: 3/9
MM: Pink, moist            CRT: 1s
HR: 140              RR: 32
LN: WNL
Temperature: Not taken

Ocular: Right eye some corneal scarring from previous descemetocoele, comfortable.
Oral/dental stage: 1/5
Cardiovascular: No audible murmur, but perhaps a little quieter
Respiratory: Tachypnoea but no marked effort. Lung sounds seem reduced. 
Gastrointestinal: WNL
Integument: WNL
Musculoskeletal: As per last exam, but further muscle wastage and weakness. 
Urogenital: WNL
Neurological: WNL, no CP deficits.

Problem list: 
1) Multifocal DJD
2) Previous descemetocoele right eye
3) Allergic skin disease - stable
4) Altered posture, curving to the left - ddx MSK pathology in cervical region vs neuropathy
5) Weight loss - ddx neoplasia vs endocrinopathy vs CRF vs other

Plan: Weight loss now very concerning. Bloods taken for NV full health profile. Ideally will try and organise abdo US and thoracic rads asap. 
Have been unable to squeeze Maya in for abdo US tomorrow with DVI, however we will proceed with the thoracic rads to begin with, and at least rule in/out intrathoracic pathology.