C10004285 / invoice 10000

Not well
Not active, not eating, bringing up foam vomit. weak and not very active.
Urinating, possible loose stools
Guilherme called this mroning and wishes Honey Pie to have more Chemo, can we please set up an appointment poss with Dr Aimee or Dr Kate, Owner has been given these Dr's names whilst DR WS is away. I'm not sure we can do Chemo and will treat when Dr WS returns.

panting one week
v+ since yesterday that has seen
inappetant today
minimal water input 

SUBJECTIVE:
Presented for not doing well, stage3a chemo patient, last chemo 3 weeks ago. Has been in and out of remission. Previous discussion, if came out of remission soon - unlikely to continue chemo. Has come otu of remission, general lymphadenomegaly but also very unwell this last two days inparticular.
1 week hx of panting, 2 day hx of vomiting, d+ inappetance, profound lethargy, not wanting to move around. 

OBJECTIVE:
MM pale, CRT 2 sec, 
HR 140, no arrhythmia or murmurs 
RR panting ++

AFAST - Marked FF in abdomen 

TX:
Maropitant 2.25ml SC
Buprenorphine 1.1ml SC

PLAN:
Discussed options - hosp + intensive care + draining free fluid to assess what it is - pending that, may require sx intervention or continued hosp vs immediate supportive carewith plan to humanely euthanise today. 

Given circumstances, it would be kind to take her final hours into consideration - and unlikely to have a positive outcome. Os have elected symptomatic care and euthanasia - husband flies out at 4, will arrive at 7. will need to arrange home euth vet at this time.