C09997845 / invoice 10000

Reason: Recheck Bloods With Tom GwHistory: Wetting herself in the house. Steroids - giving ievery other day. Drinking a lot more. History: Presenting for: Luna presented for platelet monitoring and assessment of treatment responseHistorical Conditions: Previously diagnosed with thrombocytopaenia with initial platelet count less than 10, progressing to 12, then 15, and most recently 15.8Diet: Eating and drinking significantly more than usual, which is expected and positiveCurrent Meds: Currently on tablets (specific medication not named) - was on 2 tablets once daily, then reduced to 1 tablet once dailyOther: Patient experiences urinary incontinence during deep sleep episodes, appears unaware when accidents occurASSESSMENTThrombocytopaenia - Excellent response to treatment with platelet count improving from less than 10 to current level of 41. FBC parameters remain slightly low but stable. White cell count remains elevated and RBC count requires further correction.PLANChanges to Existing Meds/Tx:- Continue current dose of 1 tablet once daily for another week instead of reducing to every second day as previously planned- Recheck recommended in one week rather than extending to monthly intervals to monitor progress closely- Plan to potentially reduce dosing after next recheck if continued improvement notedClient Comms:- Platelet levels showing excellent improvement from initial count less than 10 to current 41- Treatment responding well but requires continued monitoring due to other blood parameters still needing correction- Client has sufficient tablets for the week, additional supply available if needed- Follow-up appointment scheduled for one week to reassess progress before extending recheck intervalsDispensed more prednisilone and omeprazole--- 6/03/2026 4:10:09 PM DAM:Health Check - Skipped on 6/03/2026Heartworm - Skipped on 6/03/2026Flea - Skipped on 6/03/2026    Vital Signs    Weight: 27.1;       

Reason: Recheck Bloods - Jar Appointment Notes: with TomHISTORYPresenting for: Follow-up examination for patient on steroid treatment for IMTP with recent urinary accidents and monitoring of platelet levelsDrinking/Urination:- Two urinary accidents since last visit - one normal size, one described as gigantic- Increased water consumption attributed to steroid treatment- Normal evening toileting routine maintained but accidents occurring despite thisCurrent Meds:- Steroids (ongoing treatment)EXAMMentation: BARBehavioural: Cooperative during examination, allowed positioning for physical examIntegumentary: Significant improvement in abdominal skin condition with lesions barely visible now, bruising on legs also improvedASSESSMENTImmune-mediated thrombocytopenia - Currently at 5-7 day mark of treatment where platelet recovery is expected, clinical improvement noted with resolution of skin lesions and bruisingPolyuria and polydipsia - Secondary to steroid therapyPLANDiagnostics:- FBC to assess platelet levels and monitor for expected recovery- RBC evaluation to ensure levels are maintaining and rule out concurrent tick-borne diseasesAdditional Discussion:- Client advised that increased urination is expected side effect of steroid treatment due to increased water consumption and bladder distension- Blood test results will be available within 10 minutes- Client opted to wait for results rather than return homeClient Comms:- Explained mechanism of steroid-induced polyuria/polydipsia- Discussed expectation for platelet recovery at current treatment timeframe- Advised on precautionary testing for other vector-borne diseases despite absence of clinical signs    Vital Signs    

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