C10003988 / invoice 10000

Reason: Recheck - Needs More SteroidsAppointment Notes: 07.03.26 called LM with O to ensure they have enough tablets until recheck appt. Sent SMS. SHDNotes complete Bill completePet Primary Diagnosis/Suspected Diagnosis/Location:Suspect cause:Any other conditions being treated (if any): Known health concerns: Date of first clinical signs (if known):Intern: TB History:Phoebe is managed for hypoadrenocorticism, diagnosed 06/04/2022.DOCP generally administered by owners at home. Presented on 11/07/25 for tremoring. Phoebe was once again overdue for DOCP (~ 8 weeks from previous administration). VBG performed: PH 7.322 K+ 6.1Na 145 Lac 3.2 BE -6.9HC03 18.7Hct 59.4% Administered DOCP 1.8mg/kg SCPrednisolone increased temporarily to 5mg PO SIDRecheck on 15/08/25 indicated clinical stability. Presented to ECC on 24/12/25 for lethargy and vomiting. Metabolic acidosis and hyperlactaemia present on VBG, electrolytes stable. pH 7.391 K+ 4.1 mmol/L Na+ 149 mmol/L Ca2+1.36 mmol/L Cl- 102 mmol/L Lac 2.2 mmol/L HCO3-: 23.5 mmol/LBE: -1.4 mmol/L Maropitant administered, dispensed maropirant and ProKolin for outpatient management. OR since last visit Phoebe has been XXXXCurrent medications: DOCP (zycortal) 25mg/ml: 1.5 mls SC q5 weeks (last dose 11/07/25)Prednisolone 2.5mg SID PO Trazodone 50mg PO 1-2h prior to stressful events - PRN for anxiety Examination Findings:*Extremely dog reactive, patient taken to room 9. Could not get to scale. T:  NP                MM: not assessed, muzzledP:  120 bpm       CRT: not assessed, muzzled R: 32 bpmDemeanour: BAR, anxiousHydration: euhydrated Weight: unable to obtain body weight Body Condition Score: 8/9Muscle Condition Score: 3/3Cardiovascular: WNLRespiratory: WNLAbdomen: Tense on palpation Peripheral LNs: WNLOcular: WNLEars: WNLIntegument: WNLOral exam: NP, muzzled Musculoskeletal: WNLGait: WNLNeurological: mentation appropriate, full exam not performedRectal: NPLaboratory: QML Non-Interpreted Canine Profile -> pending Problem list:- HypoadrenocorticismAssessment: XXXXXSince re-commencing DOCP on an appropriate schedule, Phoebe has clinically improved and demonstrates improved electrolyte parameters, consistent with stable hypoadrenocorticism status. Due to reactivity and challenges with having Phoebe present to the clinic, a prescription for Zycortal has been provided for ongoing administration at home. It was stressed again, that if Phoebe clinically deteriorates, urgent review is required. Treatment:Plan:XXXXXXXNext DOCP dose 19/09/25, q5 thereafterContinue prednisolone 2.5mg PO SID Recheck in 6Mo unless any other concerns.    Vital Signs