C10007242 / invoice 10000

Reason: Suspected Internal BleedAppointment Notes: Overdue remindersConsultation Time: 3.40pm on 8/03/2026History:Buddy presented to the ECC service for acute onset tremoring and abdominal pain. He has been previously diagnosed with a splenic mass which he had a CT scan for December of 2025 (see previous history) which revealed pulmonary metastases. Since December, his O's have pursued Chinese holistic medication and believe him to be doing well since then. He also receives Chinese acupuncture once a week. EDDU NAD throughout this period. Today at lunch time he started tremoring, was slow to walk and rise and ha d ahunched posture - normally he runs for food. O's were concerned at the time and brought him to VRH for assessment. Subjective: QAR - slow to walk and hunched posture. Objective:Temp:   38.3         MM:     Pink, tacky         CRT:   <2 secs          HR:  108bpm           FP:    SYnchronous and strong          RR: 36 breaths per minCV: Normal heart sounds - no obvious murmur. No arrythmia detected or murmur. 126/87 96 MAP.     RESP: Normal lung sounds. No obvious crackles or wheezes.               GIT: Abdominal pain and tremoring elcitied on abdominal palpation.    U/G: NAD. Neuro: Mentation appropriate. Full neuro exam not performed.    M/S: No obvious orthopaedic or soft tissue injury  Integ: Previous amputation of left forelimb lateral digits. Otherwise NAD. Ophth: Eyes sunken - likely dehydrated  LNs: wnlProblem List:Abdominal pain - tremoring. Splenix mass. Pulmonary metastesis. Assessment: I believe that Buddy's tremoring is likely linked to some marked abdominal pain secondary to the growth of his splenic masses. There was no obvious abdominal FF but there is potential for intra-mass bleeds causing them to grow in size and cause further abdominal pain. Considering the overall poor prognosis the following treatment options were provided: 1. Euthanasia2. Pain-relief medication and monitoring at home, if declining then to re-present. O elected for option 2 as not keen on euthasia away from home. Advised that these situations can advance rapidly and an at home euthanasia may not be possible. O understood. Offered methadone for additional analgesia and O initially declined whilst daughter wanted it. O after discussion with daughter accepted administration and 0.1mg/kg IM methadone given. Panadol and gabapentin dispensed. Advised to start gabapentin at 10pm tonight once methadone had worn off due to sedative effects of methadone and panadol to start immediately. O's understood. Aware of possibility of rapid decline and poor prognosis, will re-present if concerned. Treatment: Methadone 0.1mg/kg IM Gabapentin 10mg/kg capsules q12h POParacetamol 15mg/kg q8h POPlan: To assess response to pain medication but if not tolerating well and responding to pain medication, O's to make a decision regarding euthanasia and re-present for this.    Vital Signs