C09995816 / invoice 10000

Reason: And Bloods? NailsAppointment Notes: Overdue remindersHistory: Exclusively on hepatic diet, Blake (son) does drop food on the ground occasionallyNo v+ or d+ recently, bout of d+ last month but resolved normallyOccasionally inappetant in mornings but eats dinner normallySimparica trio UTD, milbemax UTDOtherwise doing very wellDoes still nap during the day but not lethargic like prior to PSS diagnosisExamine: BAR nervous mm pink crt<2s oral exam G1 dental disease ln ok eetn ok chest clear HR=PR=120 abdo palp soft and comfortable on deep palpation, no obvious hepatomegalyLaboratory: mild haemoconcentration with microcytosis and hypochromasiaMild recticulocytosisAdequate platelet clumping on blood smearMild hypoglycaemia (non-fasted sample, likely from PSS)Moderately reduced urea and creatinineEchinocytes noted on blood smear, likely artefact from EDTAAssessment: degeneration of RBC likely combination of anemia and dehydration (however not clinically dehydrated), potential iron deficiency progressive from PSSTreatment: c5 vaccination SC (nobivac DHP 258102 6/27 + nobivac bb/pi 2528102 6/27)Plan: continue with hepatoadvanced and hepatic dietDiscussed potentially blood transfusion if further decline in energy or bloodwork, O's unlikely to do since temperament and anxious during vet visitsWill discuss with IW about potential iron supplementation    Vital Signs    Weight: 7.54;