C10009017 / invoice 10000

HISTORY: Reason: Recheck OA post diagnosis
History:  

Bloods last done: 14/02/2026
Abdominal U/S: 17/02/2026


Current Medications: Prednisolone 1.5 tabs BID, Gabapentin + Clonidine

Examination: 
Demeanour: BAR, Exciteable, Toy-Motivated
BCS: 6/9 
MM: pink moist 
CRT: 1.5 
HR: 
RR: 
T: 

Eyes: NAD distant exam 
Ears: NAD external exam 
Nose: NAD 
Oral: 
Dental: Grade /5. gingivitis. calculus. 
CVS: NAD no murmur / arrhythmia. 
Resp: NAD normal RE and lung sounds. 
Abdomen: NAD comfortable. normal gut sounds. 
Rectal: not performed 
Integument: 
Urogenital: NAD external exam 
MSK: NAD full exam not indicated 
Neuro: NAD full exam not indicated 

Diagnostics: 

Problem List: 

Assessment: 

Treatment: 

Plan: 
Unlikely to proceed with surgery due to age
+/- Increase Gabapentin
Continue on Prednisolone
Start Beransa today
Will call if wanting to proceed with CBD oil

HISTORY: Reason: U/s report.

U/s performed Tuesday.
P stable feeding q4hrly.  Taken for a walk one day last week and this produced a hypo event....
U/s confirmed large solitary hepatic mass - pancreas has more diffuse changes without solitary mass identified - doesn't r/o insulinoma.
Could perform insulin assay with paired BG but would need to send straight to lab. 

Still awaiting FNA results. Lou isn't available Fridays.  Nurses to contact Vetnostics to see if they can share results.
O' have indicated that they would not pursue invasive treatment as P is just to stressed to cope clinically.
FO' asked about use of pred - RW checked with text, is a treatment recorded presumably for its insulin suppressive effects >>>> recommended starting dose of 0.25mg/kg BID and can increase dose.  Awaiting FNA results.  RW to call back 


1.47pm: RW called back.  FNA results adenoma vs adenocarcinoma so is unlikely to be assoc with hypoglyceamia events.
Have dispensed pred at O' request.  Must stop carprofen.  R/c 2wks. Consider Beransa if OA pain not well controlled with pred/gabapentin.

HISTORY: Reason for consult: tremoring episodes occuring in the morning before breakfast, and then resolves after eating. O describes front legs tremoring, eyes look distant and the episode lasts around 30secs or so before he returns to his normal self.
No vomiting but has been drinking a lot of water in the last few months and occasionally will drink so much he then vomits it up. 
Is on carprofen and gabapentin for arthritis. 
Os have had him for 3 years, previous to that he was on a farm and Os became too old to look after him. 

Current medications: gaba, carprofen
Current food: biscuits and wet food

PEx:
Demanour: BAR, terrified of being inside the consult room but really good outside in garden. 
BCS: 6/9
Integ: nad
Oral: mm pink and moist, CRT 1-2s
Lymph nodes: wnl 
Dental disease: grade 1, mod wear of teeth
Ears: nad
Eyes: nad
Nose: nad
CVS: HR wnl and rhythm wnl and no audible murmur
Resp: Lung sounds clear, resp rate wnl
Abdo: relaxed and comfortable
MSK: wnl - no current lameness, full MSK exam not performed. 
Temp=not taken
Pain score:

Assessment: 
Tremors which resolve with food
PU/PD - suspected

Bloods:
CBC - WNL
Biochem - mild hypoglycaemia, mod amylase elevation

Treatment and Plan: 
Hypoglycaemia is very concerning and at that level he is borderline seizure risk!
Given he is not symptomatic right now and very bright and alert gave O options:
1. Refer to emergency immediately, may not get specialist US until monday anyway
2. Take home and feed frequent meals (split into 4 meals, give last one as late as possible)
3. euthanasia

Os were not at all thinking he is ready for euthanasia, still a very bright and energetic dog, only current illness is arthritis and bloods otherwise good. O wanting to take home and do option 2. Will try organise URGENT abdo U/S for monday with either Kerri or Lou.
Advised of treatment options - surgery is generally the only option if he is a candidate. Can talk more once we have US results.

15 Feb 2026 12:25:02 pm DH
STO for update on how he went overnight - O gave last meal at 11pm nd slept on couch next to him all night. No tremors this morning and had breakfast at 5am. Gave O rough est of 850 for US and will call in the morning with plan on who is available. To give chill pill 2hrs prior and will likely need IV sedation due to fear - no aggression just goes into full panic/freeze mode when inside the clinic.