C09998887 / invoice 20000

Reason: PainfulHospital time period: 0600-1800History: Represented for breakthrough pain, see prev for full HxInitial consultation with DrRL, verbal handover- 25mcg/hr fentanyl patch fell off yesterday 1700- 100mcg/hr fentanyl patch is partially not adhered to skin- 1hr of screaming at home prior to representation - Plan for replacement of fentanyl patches, ketamine SQ for breakthrough pain. O to go home and AEC to contact once ready to go home Ketamine 1mg/kg SQ received at 0530Subjective: QARObjective: Temp    38.1    MM     pink         CRT       <2s      HR      104       FP strong and equalBCS:   5/9                       Wt:  30.7 kgPain Score (GPS):   7/24 > 10/24CV:  no murmur ro arrhythmia       RESP:   normal respiratory effort     RR 20GIT:   NSF, not closely assessedU/G:  NSFNeuro:  quiet mentation (ketamine 1mg/kg SQ given previously)M/S:  ambulatory x4Integ:  bandage placed over biopsy site by O, not removed until more comfortable. Biopsy site not assessed Ophth:  NSFLNs: NSFProblem List:Breakthrough pain - L epaxial mass - Malignant sarcoma Assessment: Ddx breakthrough pain, wind up pain vs anticipation of pain likely contributing- Crying and vocal when shaving distal LHL for fentanyl patch, although this was not anticipated to be painful, and subsequently settled without further intervention. Anticipation of pain is likely - Also starting to cry and vocalise with intrascapular SQ injections with 25G needle Plan to manage with PO medications and SQ methadone until fentanyl patches activeHistopathology indicates malignant sarcomaTreatment:Ketamine 1mg/kg SQ received @ 0530 by DrRLFurther ketamine 1mg/kg SQ @ 0640Methadone 0.3mg/kg SQ q4hFentanyl patch 100mcg/hr + 25mcg/hr placed @ 0730 06/03 on LHL (under vet wrap); active 1930Plan:O to visit Duke and spend time, see if comfortable taking home to spend timeIf O not comfortable taking Duke home then will elect humane euthanasia tonightClient communication:--- 06/03/2026 09:45:46 ZLI: SMS update sent, see comms log--- 06/03/2026 11:20:10 ZLI: O dropped off PO medications and visited Duke. Updated on analgesia so far, plan to keep for monitoring and SQ medications in hospital while awaiting histopathology. Sx team has contacted lab to see if can expedite, awaiting for contact back re ETA. Fentanyl patches to become active tonight. Advised O medication fees only today, nil hospital charges which O is grateful for (Sx team happy with plan)--- 06/03/2026 16:02:24 M1J:Called owner and let them know that the mass is a malignant sarcoma, likely haemangioracoma, prognosis is poor and it is not resectable. Discussed they could get further information from oncologist but unlikely to be a good treatment options. Discussed home euthanasia or euthanasia here or at the ref vets, owner would ideally like to take him home to spend a day with him if he is not painful. I said this would be ok if not in lots of pain.--- 06/03/2026 17:42:12 ZLI: STO Duke has remained settled but with handling continues to show pain vs anticipation of pain. Recommend O present to visit and spend time with Duke, and see if comfortable taking home to spend time vs humane euthanasia tonight. If taking home offered to provide options for home euthanasia services however O more comfortable with this being performed at AEC. O can present any time for euthanasia request and we will do our best to accommodate. STO in person during visit, introduced PM vet looking after Duke.    Vital Signs    

Reason: EuthanasiaExamination/assessment:- lumbar mass present, extremely painful- fentanly patch seems active, previously screamed with even SC injections @6.30pm, Rhiannon came in for a visit to decide whether to take Duke home to be presented for euth tomorrow with AEC VS euth tonight. Decided for a euth tonight given how painful he is and does not wish him to be in pain overnight. Highly supported owner's decision. Euth form signed. Treatment:Medetomidine 30mcg/kg SC, for IV cath placementEuthanasia with pentobarbitone IVPLAN:Individual cremation w Eden Hills    Vital Signs    Weight: 30.7;