C10007777 / invoice 10000

Reason: Wants More Metacam MsAppointment Notes: Special payment terms exist, Overdue remindersPlan:Ok to continue for palliative treatmentGap Only Summary: metacam palliative carePet Primary Diagnosis/Suspected Diagnosis/Location: neoplasiaSuspect cause: neoplasiaAny other conditions being treated (if any): nlKnown health concerns:Date of first clinical signs (if known): ongoing    Vital Signs    

Reason: KC - Owner Would Like To Talk To You Re UltasoundAppointment Notes: I have updated hx & adviced that she should come in on a Thurs - CNKc spoke with JayCaesar improved very well with antibiotic courseHe is very bright and playful, loves the puppyAppetite has returned to normal, feeding 3 times daily, he would like moreNo vomitingPassing urine and faeces without strainingLameness has improved, still present occStill on metacam SIDPain appears well controlledPlan: discussed ultrasoundCurrent treatment is palliation for likely neoplasia of bladder and stomachCurrent QOL seems goodGave O the option of a repeat ultrasound - to assess progression of neoplasia, but this is unlikely to change our treatment planOr,Continue palliation, use antibiotics as needed for infection, add pain relief if requiredEuthanasia if unable to pass urine    Vital Signs    

Reason: R/r Leg Limp & Trembling Before Bed - RBAppointment Notes: Special payment terms exist, Overdue remindersHistory:Has been doing well until quite recentlyHas a new puppy which initially kept him active.  Now seems to tire easily and get grumpy quicklyAppetite has been great until last couple of daysNo vomitingDefecating less - O worried he is struggling with thisHas a good urine stream and no visible blood in urineO had booked him for follow up US with KC on thursday.Last night suddenly lame R hind.  Worried he has fallen down the stairs with the puppyExamination:COAT/SKIN: No skin lesionsEYES/EARS: clean and clearMOUTH/TEETH: MM pinkHEART: HR 136.  Temp 40.7LUNGS: Normal BVS all fields.  RR 24ABDOMEN/DIGESTIVE/URINARY: Abdomen not tense.  Bladder small (large urination this am) but firm as expected with the tumorCNS/MUSCULOSKELETAL: Generally weak and struggles to rise.  All weight on L hind.  Placing reflexes seem normal.  PERIPHERAL LYMPH NODES: WNLWEIGHT/DIET: Body Condition Score: Not weighed but O thinks may have gained weight as was feeding him whatever he wantedLaboratory:  Moderate anaemia HCT 29.5, worse than last bloodsWBC 33.71 Neut 29.71CRP >100Renal and hepatic parameters WNLAssessment: Likely infection, could be necrosis of one of his tumoursMay also be further metastasis contributing to lamenessTreatment: Add paracetamol to meloxicam for pain.  Can also add Gabapentin but would need to watch for ataxiaEmpirical amoxyclav Tx Plan:Keep appointment with KC on thursday for reviewHave advised O that if poor response to treatment, prognosis os guardedPet Primary Diagnosis/Suspected Diagnosis/Location: Bladder neoplasia with secondary infectionSuspect cause: Bladder neoplasia with secondary infectionAny other conditions being treated (if any): NilKnown health concerns:  as aboveDate of first clinical signs (if known): ongoingTo be filled in prior to submitting claimAdditional notes can be added later    Vital Signs    Temperature: 40.7;