C10003566 / invoice 10000

Reason: ShakingHospital Time Period: 1010History:BIOP since 3 years old.O has another Dachshund at home, from same mother. UTD w vx and worming. Been a healthy girl otherwiseHx of inappetance, been to RV on Tuesday for check up. Opted to monitor at this stage.Been to RV again on Friday as had no improvements. Performed blood test, and results came back through on Saturday, which showed elevated WBCs (O showed the results via phone).Upon questioning Elsa came on heat approx 1 month ago but not 100% sure. Last night O noticed discharge leaking through back end, unable to settle. Peeing a lotBreathing up easily.Subjective:QARObjective:Temp: 38.7           MM: pink             CRT: <2s            HR:112             FP: fair, sync             RR: 28 BCS:    5/9                Wgt:   6.7 kg Pain Score (CSU):   1/4CV: no obv murmur or arrhythmias audible, no pulse deficits  RESP: clear BV Sounds bilat, RE and RR adequateGIT: abdo palp mildly tensed diffusely U/G: swollen vulva, leaking mucopurulent discharge Neuro: nil ataxia, QARM/S: able to rise x4, although prefers to be on sternal recumbencyInteg: nsfOphth: nsfLNs: nsfQuick AFAST:Fluid filled structures adjacent to urinary bladder, no obv FAFProblem List:Vaginal dischargeInappetanceLethargyHx of elevated WBCCsAssessment: Given signalment, hx of onset of symptoms near end of estrus cycle, systemic signs of illness and vaginal discharge, loops of fluid dilated tissues noted on AFAST, strong suspicion of pyometra, open type.Recc hospitalisation for pre-op supp care, pre-GA bloods, ovariohysterectomy. P would require post-op care.Discussed the case and rx options w O:1. Admission to hosp for diagnostics, supp care, OVH, post-op careO would like to know if O's insurance will coverAlso discussed transfer to another facility eg. LSAH should finance could be an issue.2. Transfer to another facility3. Outpatient symptomatic treatment, follow up w RV, not recommendedO requested to check if insurance will cover, called GAP only, acquired pre-approval.Told O of this, O opted to take Elsa to LSAH for ongoing care at the end. Treatment:NilPlan: Diagnostic plan : TBC - cbc, biochem, radiometer, pcv/tp, AFASTTherapeutic plan : TBC - ex-lap, OVHDischarge plan : n/aReferral plan : n/aClient Communication:Called LSAH, 3.5-4k pyometra, could increase est to 5k.    Vital Signs