C09994029 / invoice 10000

Reason: Check UpAppointment Notes: Overdue reminders  ------- Sms reply: YHistory: Stopped medication 6 weeks ago Eating and drinking normally No vomiting 3 days ago No diarrhoea Concerned yesterday left eye scleral redness Reason for consultation:-- Duration:----Any other issues:Up to date with prevention:       -- yes/no -       -- type - Medications on currently - Examine:-- BCS: -- Temp: 38.4 -- MM:  pink-- CRT: 2 secs-- Cardiovascular:      -- HR:     -- No obvious murmurs or arrhythmias     -- or murmur - grade -  -- Respiratory:     -- RR:      -- Respiratory effort - No increased insp or exp effort     -- Respiratory sounds - Normal bronchiovesicular lung sounds     ---- Abdomen:     -- Pliable, not painful, no masses obvious on palpation    ---- Oral:    -- Examination:    -- Dental score: -- Eyes:     -- No abnormal ocular discharge,    -- No conjunctivitis    -- normal sclera,     -- Pupils symmetrical.     -- Retinal examination normal.     -- Lens normal position and normal opacity.     -- Eyelids normal-- Nose:     -- Normal confirmation or brachycephalic    -- No sneezing.     -- No nasal discharge.     -- Normal symmetry. -- Integument:     -- Clean coat,     -- No dermatitis or skin lesions present.    -- Normal skin turgor    -- No fleas or externa parasites    ---- Ears     -- Left ear - normal canal with no discharge. Normal pinna    -- Right ear - normal canal with no discharge. Normal pinna-- Lymph Nodes:     -- all palpable external lymph nodes normal size and shape-- Musculoskeletal:     -- Ambulatory with no lameness.     -- Joints palpate normally.     -- Normal musculoskeletal exam    ---- Neurological:     -- Mentation - BAR.     -- Normal CN function.     -- No ataxia noted.     -- Normal neurological exam     ---- Rectal exam: -- Reproductive:     -- n/a (de-sexed)     -- or normal reproductive examination     -- or prostate/testicles/penis normal    -- or vulva/mammary tissue normal -- Behaviour: -- dental tartar mild -- lump ventral chest chest lipoma Problem list: 1.Lipoma  ventral chest 2.3.Plan: CBC to assess platelets for IMTC previous therapy Laboratory: Folow up bloods to assess platelets Assessment: Assess platelet count from previous therapy been off cortisone past 6 weeks Differential Diagnosis: Diagnosis:Platelet count normal Treatment:CBC to assess platelet count Subjective:- Revisit following completion of cortisone taper for suspected immune mediated thrombocytopenia- Stopped medication over 6 weeks ago; tapered to half tablet for final 2 weeks- Weight gain: now 10kg (previously 8kg, already overweight at 8kg)- Fat pockets have grown larger- One vomit 3 mornings ago after finishing breakfast- Scleral redness left eye 3 days ago, now resolved- No diarrhoea- Eating and drinking normal amounts- No bruising noted on regular belly checks- Lump ventral chest: present for 3-4 years, approximately twice the size of 3 years ago; previously aspirated 2-3 times at Terry Hills with fat only, cells wiped off slide; once became red/purple after suspected cat attack but dissipated within 10 minutesPast Medical History:- Suspected immune mediated thrombocytopenia treated with cortisone taper- Previous presentation with haemorrhages visible across ventral abdomen and neck swelling at venepuncture site- Chicken allergy- Diet: kangaroo meat, small amount of Yakult, coconut oil, simple protein kangaroo kibble- Regular exercise, aiming for 2 walks dailyObjective:- Weight: 10kg- Eyes: blood vessels visible in scleral region right side, conjunctiva slightly red when pulled down, no bruising, corneas clear- Gums: no obvious redness or bleeding- Lump ventral chest: present, consistent with lipoma- Neck: fat deposition, no current swelling- Teeth: mild tartar staining on upper canine and molarAssessment:- Suspected immune mediated thrombocytopenia - follow-up post therapy- Lipoma ventral chest- Weight gain secondary to cortisone therapy- Mild dental tartarPlan:- CBC to assess platelets as follow-up to immune mediated thrombocytopenia therapy- Weight reduction: reduce total food volume, account for treats in daily intake- Increase chewing for dental health: green beans or plant-based chews recommended- Teeth cleaning to be deferred until weight normalised- No surgical intervention for lipoma at this stage- Results to be communicated via phone, potentially tonight or tomorrow morning- If platelets low, will contact immediately    Vital Signs    Weight: 9.95;