C10004800 / invoice 20000

See prev hxCurrently on pred, traz, was prev on gaba (100mg) with little effectPanting a lot, crying at night, drinking a ton of waterRequiring diaper as urinating a lot too Cannot walk at all KS has sched at home euth for Sunday PE - QAR, in stroller, panting/whiningMMs PMBladder empty, diaper very wet - voiding fine today anywayDid not attempt to examine gait As voiding bladder well, main discussion today is to manage pain/anxiety so he can sleep well. As already on 1/2 traz SID, can increase gaba to see if that helps, and INI can discuss increasing traz. KF is happy to be contacted about this case at home on her days off. KS appreciative.KF    Vital Signs    

Appointment Reason: Back pain, Appointment Notes: KVA explained this phone call will incur a recheck consultation fee- O happy and happy to proceed.Phone consult -- Remy had MRI yesterday, O understands that specialists will run through findings and that specialists are the main point of contact for this, Kayane just wants to also talk to Karen as a personal choiceSt Kayane via phoneWritten hx from yesterdays MRI not available yet, but likely peripheral nerve sheath tumour in neck  per O - already spreadNeuro has reportedly said that radiation/chemo not helpful in these cases, surgery may or may not be but is VERY intense, recovery-wiseSo Kayane has opted to do palliative careCurrently on 2 pred SID  (did not confirm which tab size)- bit whiny! Discussed that pred could probably be split up to BID to reduce SEs but can also check with neuro just in caseWheelchair prob not a good option as affects entire L sideThey will want to do home euthanasia when it's time - can attempt to sched with us but depending on factors might be a RYP visit insteadExpressed our most sincere sympathies - Remy has been one of my favorites for a long while and I am happy to hear from her if she has any questions I can answer on days I'm not hereKayane appreciativeKF     Vital Signs    

Appointment Notes: express bladder - show owners howHistory:- IVDD - progressing now, can't move HLs, and LFL stiff/extended- Hasn't urinated since 630pm last night, but not drinking that much- Currently on Pred 5mg PO SID, Panadol, and Gabapentin- Ideally wanted to be seen at SASH but neurologist appointment in 3 weeksExamination:- BAR- MSK - HL paralysis, and LFL extended - deep pain present but no proprioception on LFL, and HLsBladder - size of a plumb, expressed urinePlan:- Discussed the need for urgent referral to SASH ASAP for further assessment and advanced imaging/surgical management as indicated.- Explained that urinary retention is concerning for possible neurologic dysfunction secondary to IVDD. Loss of normal bladder function may indicate progression of spinal cord involvement.- Advised that bladder was expressed during consult; however, patient may require repeat bladder expression in the morning with close monitoring overnight. Discussed that ongoing retention may necessitate placement of a urinary catheter at SASH for appropriate management and monitoring.- Emphasised that owners are not to attempt bladder expression at home due to significant risk of bladder overdistension and potential rupture if performed incorrectly.- Need specialist level care nowPlan:- Arrange urgent referral to SASH Sun or Mon. Book patient in with Surgery/Medicine service for further evaluation and management, as we can't wait 3 weeks to see neuro.- Need to consider QOL and 50:50 chance with spinal surgery pending there are no tumors or neoplastic process involved too - Monitor for ability to urinate voluntarily, comfort level, and neurologic status until referral.Prognosis:Guarded pending specialist assessment and response to treatment.    Vital Signs    Weight: 9.4;       MMColour: Pink;       HeartRate: 100;