C09995965 / invoice 10000

--- 06/01/2026 11:49:38 LR2:BOVA Meds ArrivedMedication: Cannabidoil 25mg/ml. Qty: 50ml Directions: Give 0.1mls SID, Increase by 0.1mls each week until ideal dose. Do not excees max dose of 0.45mlsExp: 5/4/2026    Vital Signs    

Nurse: --- 31/12/2025 13:03:31 TYFRest your paws email for pallative care back from the 8/10/2024Hi StellaIt was such a pleasure to see you, Skye and Pegasus the other day. How did Skye go with his first couple of gabapentin doses at night? As I mentioned, this email will summarise our current plan, list some resources, and provide contact details to keep handy. This email contains a lot of information, so take time to process it and let me know if you have any questions. We know that the wonderful Skye has a lot going on in that little body of his, but his quality of life at the moment is still pretty good, and he is still enjoying food, being with you, and going on walks. It seems at the moment, the 3 things we need to focus on are his:Kidney disease Doggy dementia - click here for a blog on the topicArthritis - click here for a blog on the topicPlease let me know if you have questions about any of these.From our discussion, I gathered that our goals for Skye’s care are:To improve his comfort and address the nighttime restlessness (more sleep for everyone!)Keep him comfortable and stable for as long as possibleSay goodbye at home when everyone is readyDoes this sound about right? Please let me know if there is anything else I need to keep in mind. As we discussed, the progression of Skye’s disease is likely to be one of the below outcomes:Event that leads to sudden decline, such as collapse, neurological event or other.Slow decline in quality of life and enjoyment, including reduced energy, appetite and engagement.Breathing changes, including struggling to breathe.Disease change or advancement that impacts other parts of the body, such as the brain or failure of other organsI know it is hard to think about these outcomes, but we plan to say goodbye before any of that happens, and we will do everything in our power to avoid those scenarios.Below is the medical plan we made together to support Skye:Book in with Coreen Avenue for blood tests (kidney and liver parameters important), urinalysis and urine protein:creatinine ratio (assess if losing protein in urine)Continue Fortekor at 2.5mg morning and night, pending test results (may need to increase to 5mg)Continue Clopidogrel as previousStart Gabapentin 100mg (let me know when you need more, and I can write a script). It will relieve pain and also help him sleep.Give half (½) at night only for 3 days, then half (½) morning and night for 3 days, then increase to one (1) morning and night ongoing. We can increase if needed. May cause wobblinessStart CBD Oil 50ml of 20mg/ml (left a script for compounding - click here for one I recommend) - pain relief and will also help him sleep. Week 1: Give 0.1ml at night; Week 2: Give 0.1ml morning and night; Ongoing: Increase by 0.1ml weekly until the ideal dose is achieved. The ideal dose balances pain relief without being too sedating. The max dose is 0.8ml twice a day. Other medications we can consider, depending on the test results and how he is going include:Amantadine (helps to reduce the hypersensitivity/amplification of pain that results from chronic pain) - Can cause temporary diarrhoea in some dogs.Panadol (pain relief) - pending liver values - Can cause temporary diarrhoea in some dogs.Nonsteroidal anti-inflammatories, e.g., meloxicam or rimadyl (pain relief), can put his kidneys at risk but can significantly increase comfort if kidney values are stable. To reduce risks, we can give one dose every two or three days, rather than daily.Selegiline (Can improve the signs of doggy dementia within 4 - 6 weeks)Melatonin (can help with sleeping, works well for doggy dementia) - The CBD oil and gabapentin may be enough to help him sleep through the night. If this is not the case we can add melatonin after a couple of weeks. If the kidney disease progresses and his appetite declines or he begins vomiting, I recommend we start supportive medications ASAP - keeping up his food intake is vitally important. Medications we can use if that happens include:Cerenia (antinausea and stomach pain relief)Mirtazapine (appetite stimulant) Ondansetron wafers (nausea)Let me know if you would like to have these medications on hand in case things change quickly—I can send you prescriptions. How do you feel about this plan?MONITORING:I recommend monitoring for the following:Pain and discomfort, including scoring - See this resource for more information and scoring tools.Gum colour - should be pink.Gastrointestinal signs, including vomiting, increased diarrhoea, constipation, and continued inappetence.Swelling of the abdomenAny behavioural changes, including reduced engagement with surroundings and familyContinued restlessness at night even after 2 weeks of gabapentin and CBD oil Breathing changesNostril flaring when inhalingChanges to posture, such as sitting up with chest outFinding it difficult to lie down and rising from sleep regularly to hold up chest Coughing or hacking, particularly when it is productiveIncreased breathing effort (audible breathing, increased effort required, including big abdominal movements)Increased breathing frequency when awake  (Will vary between 10 – 50 breaths per minute based on exercise and temperature) - If consistently 60 breaths per minute on a mild day and not associated with exercise, indicates breathing difficulties - give us a call ASAP.Resting respiratory rate (While deeply asleep, count the number of breaths taken in 1 minute – or in 15 seconds and then multiply by 4) – This should be between 10-20. If over 30 breaths per minute, let us know ASAP.Wobbliness, absent staring or other neurological signs If you are concerned about any of this, please reach out.Contact numbers to keep handy include:The Rest Your Paws main phone line, with someone available to speak between 8am and 11pm 7 days a week: 0422 157 675The Veterinary line, either myself or another vet will answer or get back to you when possible. Recommended to only use in non-urgent enquiries: 0485 950 208Your local emergency hospital, such as SASH or SVES Lastly, I wanted to stress the importance of caring for yourselves throughout this process. As hard as it is, I hope you enjoy this time together. Thinking of you all,    Vital Signs