C10003384 / invoice 10000

Reason: Recheck --- 06/03/2026 18:38:50 DH:Owner refused to pay total amount. I tried multiple times to explain the charges & credit to her but she would not understand. Insisted she only owed the $200.60KT witnessed my conversation with ObesityHISTORY: here today for revisit owner advises ate last night but not this morning Owner wants to go ahead with further diagnosticsOwner wanting refund on hepadvanceOwner wants to know if this test will get a diagnosisEXAMINE:Did not examine as bitesPLAN:Given estimate for fna/pt/ptt/cytologies to lab Discussed with owner may not give us all info and biopsy of liver indicated but this more risky and expensiveAdvised we do not offer refunds - owner wanted me to talk to practise managerHanded over to Dr Peter--- 06/03/2026 18:02:00 AV:AV dischargeO struggling to give hepatoadvanced tablets and requests refund - advised o will need to check with management on monday but unfortunately dont think we can refund dispensed medication. Recommend o to continue trying to give tablets at home. Cytology samples to lab tomorrow - FNA of liver and effusion sample/cytology for analysis - hope to get results by tuesday but cannot guaranteeO to call if any concerns over weekend, otherwise wait until results back for vet call--- 07/03/2026 10:16:46 ND:QML checked and ready for collection    Vital Signs    Weight: 5.3;       

Reason: Had Convulsions At 6am For 45mins. Appointment Notes: Walk in. a bit shaky now.  BMHistory:  Seen 4d ago for d+ started on metronidazole - d+ improved, not passed any f+ last 24hrs but also not very interested in food Tremors for 45 mins this morning still conscious but urinated slightly Slow recovery Only offered milk no food this morning - drank the milk Examine: BARBCS 4/9 but mild distended abdomen  HR 130 no murmur noted MM pink sl tacky unable to do full oral exam Tense abdomen F+ on perianal fur Unable to take temperature - snarled and tried to bite - (sedated temp 39.1C)Will need sedation for diagnostics Plan: Admit for sedate and full bloods + further diagnostics as indicated --- 05/03/2026 09:26:38 BM:Emailed GAP (vethelpline@petsure.Com.Au) for pre approval. Sent through Vets consults notes and a snippet of Estimate in consult for GAP. BMTreatment:0.1ml dom 0.1ml torb SC good level of sedation - blood sample taken for in house bloodsJaundice noted on sedated exam IV catheter placed, Hartmanns started at 5ml/kg/hr Laboratory: Haematology Regen anaemia Low platelet countBiochemistry Liver values elevated Hyperglobulinaemia Blood smearSome platelet clumping at edge Assessment:Hepatopathy - called client and recommended abdominal US - o consented Laboratory:++ FF throughout abdomen Liver very abnormal - rounded edges, heterogenous appearance Client consented to abdominocentesis Clear straw coloured fluid - SG 1.010 TP 5 Low cellularity Assessment:Advanced hepatopathy with secondary ascites Possible hepatic encephalopathy as cause of seizure like activity this morning Plan:Cookie very stressed and aggressive in hospital (bit nurse even when sedated) - plan to discharge home overnight with IV catheter in place and recheck tomorrowStop metronidazole Commence hepatoadvanced Dispensed diazepam tablets in case repeat seziure like episode - advised o to give one dose and if no improvement to call afterhours number Discussed all diagnostics so far suggestive of neoplastic disease but cannot confirm without FNA or biopsy of liver - o happy to discuss this at recheck tomorrowTomorrow: - Consider sending off fluid samples + liver FNA for cytology - discussed at length cannot guarantee diagnosis from this but will give more information - Will need to check clotting times before FNA + will require repeat sedation - Guarded prognosis regardless - If opt not to pursure further diagnostics recommend palliative care + PTS when ready    Vital Signs    Weight: 5.8;       

Appointment Notes: Overdue remindersReason: Supply DrugsCommunication: Owner confirms is currently giving ...... tabs SID/BID/TIDConfirmed this matches current medication instructionsLast veterinarian visit DATE:...........Medication prepared by ...............    Vital Signs