C09999044 / invoice 10000

Reason: Echo With GeoffAppointment Notes: Overdue remindersMissed billing from previous EchoMC    Vital Signs    

Reason: Echo With GeoffAppointment Notes: Overdue remindersHistory:Leo is a 11y5m MN Maltese X presented today for echocardiogram. O reported that he is doing well at home. Previous health problems: noneCurrent medications: noneDrinking/ Appetite: unchangedUrination/Defecation: unchangedExercise tolerance: unchangedAccess to toxins: noneExamination:Demeanour: BARBCS: 4/9MM: pink and moist                  CRT: <2 sec              HR: 120 bpm                RR: pant            Temp: not taken Eyes: Clear and bright bilaterally, no ocular discharge or blepharospasmEars: Clean bilaterally, no evidence of discharge or malodour, no signs of erythemaOral exam: C3G2. Appropriate dentition present with normal occlusion, no evidence of cleft palateCardiovascular: Normal cardiac rate, rhythm and intensity. No arrhythmia noted. Heart murmur grade 4/5.Respiratory: Clear bronchovesicular sounds bilaterally, normal respiratory effort and soundsAbdominal palpation: Soft and comfortable, no evidence of abdominal hernia, no marked distension, masses or painUrogenital: No abnormalities noted, external genitalia present with no evidence of discharge or swellingIntegument: Clean coat overall, no signs of erythema, no ectoparasites presentLymph nodes: Submandibular, prescapular and popliteal lymph nodes are regular, symmetrical and palpableMusculoskeletal: Symmetrical musculature, ambulating comfortably with even weight distribution. Able to right, rise and ambulate. Full musculoskeletal examination not performedNervous system: Appropriate mentation, no overt cranial nerve deficits. Full neurological examination not performedAssessment:Echocardiogram- Stage B2 MMVDPlan:To return for TAHP blood collection with gabapentin on board. To return in 3 weeks to check kidney values (creatitine) after starting pimobendan O to limit exercise (mild levels only), record sleeping respiratory rate and return if any concerns. To start on pimobendan today.DISPENSED1) Cardisure 2.5mg - 1 tablet BID 1 hour before foodClient communication:Discussed with O that Leo is diagnosed with Stage B2 MMVD. Offered to explain disease but O revealed he is a doctor. Advised O to do daily recordings of Leo's respiratory rate when he is sleeping and advised normal is <30 breaths/min.Advised O to restrict exercise to mild levels only.Advised O to return in the next few days to retake TAHP bloods so we can compare kidney values 3 weeks later.Discussed with O that life expectancy with management is 3 years.    Vital Signs