C10001630 / invoice 10000

Previous Complaint/Diagnosis - 
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History -
         How has disease progressed? -  Had a bout of tremoring and shaking and vomiting/diarr at home thne rushed to PVE yokine and was back to normal in waiting room. then went to park and was happy playing with dogs and chasing carrots at home at full speed, but some days miserable 

         Medicine Hx  -
         Appetite   -
         Toileting  -

Examination -
         Attitude - BAR 
         Temperature -  n/a 
         Heart -   HR. Murmur - 
         RR -
         Other key findings = 

Assessment   - 
Problem List   -  Complicated and multiple  ... Cushings, proteinuria 

Discussed        -  O is conflicted as Lottie fluctuates day to day. Would like to repeat bloods and UPC today. Not tried mycophenolate yet. No luck with urine sample so O to bring a sample at some point. Trial codeine for pain as needed. O is now using the trilostane on and off and the cushing symptoms are starting back up again, but with trilostane the appetite seems to be affected. The episode o described seemed to be consistent with acute abdo pain, which could be related to gall bladder issues eg mucocele 

Treatment Plan - 
Prescriptions(on-going) - Zofran trilostane temisartan 
Next Visit            - as req 

Previous Complaint/Diagnosis - renal disease, cushings
main concern not eating
was wet this am - unusre if urine ? no water bowl. not noted before . otherwise urinating normally (possibly 
fleur called earlier in the week - left message 

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History - dry retched thismorning , no D+
         How has disease progressed? - 
         Medicine Hx  -zofran 5am, prokolin, no gaba
         Appetite   - hasnt eaten much, can of tuna this am - not interested in other food
         Toileting  -
Examination -
         Attitude -bar
         Temperature - 38
         Heart -112   HR. Murmur - n
         RR -
         Other key findings = mm pink not dehydrated
Assessment   - 
Problem List   - 
Discussed        - doing ok atm, still not 100% but ok. o happy to have her at home (o mum is coming to help look after her). ok to feed whatever she will eat. cont on meds for renal disease (benaz, telmisart), but not trilostane or mycophenolate. also cotn with gaba. +- zofran prn
feeding tuna ok - whatever she will eat
longer term o going to monitor clinical signs/medicate as needed and probs not see Animalilus again, just palliate with us. 
will just monitor clinical signs - ok as long as eating/drinking /happy 
Treatment Plan - benaz, telmisart, gaba, zofran 
Prescriptions(on-going) -benaz, telmisart, gaba, zofran
Next Visit            -as needed

Conversation with Owner regarding patient: lottie update:
**Clinical Summary:**
Patient presented for follow-up regarding ongoing vomiting and diarrhea. Currently hospitalized with intermittent vomiting episodes. Owner attempting various feeding methods with partial success - patient occasionally holding down food.

**Treatment provided:**
- IV fluid therapy administered
- Antibiotics given (injectable)
- IV catheter placed (patient has self-removed catheter once today )

**Discussed with owner:**
- Potential for additional antiemetic injection (likely maropitant) if vomiting continues - last dose given approximately 6 days ago
- Main concern is preventing dehydration and subsequent renal complications from fluid losses due to diarrhea
- Physical exam today: no clinical dehydration detected, skin turgor WNL

**Plan agreed:**
- Continue current supportive care
- Monitor hydration status closely given diarrhea
- Recheck appointment scheduled for 9:30 AM tomorrow
- Prescription for compounded gabapentin (chicken flavored) to be organized through compounding pharmacy for easier administration at home
- Owner to continue attempting feeding and monitor for any deterioration

**Home care instructions:**
- Continue offering small amounts of food
- Monitor for continued vomiting/diarrhea
- Watch for signs of dehydration or lethargy
- Bring patient in for 9:30 AM appointment tomorrow
- Contact clinic if condition worsens before scheduled appointment

The above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.