C10006309 / invoice 20000

Appointment Notes: Call re bloodsRefer to prev consult for notes    Vital Signs    

Reason: NPC - Annual Vaxs (AH)Appointment Notes: Harry (Dog) - Vaccinations [Veterinarian : Dr Iris Tang(No Preference)] - Vaccination dueWeb BookingClient name: laetitia SmithContact number: 0450505683Email address: laetitiatillman@gmail.comPatient name: HarryHistory:Presenting for annual check up and vaccinations. Prev had U/S and bloods - biliary sludge and marked elevation of ALP - was put on hepatoadvanced and ursofalk, recommended to repeat bloods. Was not done - to do bloods today. No PU/PD/PP noted. EDUD normal. No vomiting or diarrhoea. No lethargy. Microchipped Worming product used - Milbemax Flea/tick product used - Bravecto chews Heartworm product used - Proheart  Diet fed - KibbleClinical Examination:Mentation: BAR Demeanour: Friendly HR: 90, no murmurs or arrhythmias  RR: 20, lung fields clear Eyes: NAD Ears: Lichenified external pinnae from chronic history of otitis externa, not currently pruritic or inflammed, no discharge. LN: NAD Coat: NAD Fleas seen: NAbdomen: Comfortable on abdominal palpation, gut sounds normal, no organomegaly or masses noted.  BCS: 6/9 Dental: Grade 2/4 periodontal disease, moderate tartar accumulation on premolars L>R side, mild gingivitis Limbs: Ambulating well, weight-bearing on all four limbs. No discomfort or pain on MSK exam. Laboratory: Today: ALT 267 U/L, ALP 869 U/LSept 25: ALT 221 U/L, ALP 1041 U/L Findings: Fit for vaccinations - start lepto 2 Elevated ALT and ALP  - prev abdo U/S showed biliary sludge, bloods had ALT and ALP elevations. No other clinical signs reported. Consider continue hepatoadvanced and ursofalk for a month then recheck for reduction in ALT and ALPOverweight - recommended reduce feed, BCS 6/9 Grade 2/4 periodontal disease - discussed dental S+P, dental prophylaxis Treatment: Vaccinated Annual BSO & Pi2BSOVaccine Batch No. : 5245048AVaccine Expiry Date:  10/2/27Pi2Vaccine Batch No. : 5264018Vaccine Expiry Date: 25/2/27Vaccinated Nobivac Lepto 2 (L Interrogans SG Icterohaemorrhagiiae SV Copenhageni + L Interrogans SG Australis, SV Bratislava)Vaccine Batch No.: A003A02Vaccine Expiry Date:  10/2026Proheart SC 1.3ml Restart: Ursofalk - 5ml PO SID  Hepatoadvanced large dog - 1 tablet PO SID Plan: Lepto 2 booster due in 4 weeks Weight loss recommended - ~2kgContinue Ursofalk and hepatoadvanced for 4 weeks then recheck ALT and ALP to assess for reduction in value - do lepto booster at the same time Estimates given for any procedures discussed.    Vital Signs    Weight: 24.4;       

Reason: Fluoxatine PlsAppointment Notes: Special payment terms exist, Overdue reminders    Vital Signs