C10009665 / invoice 10000

Reason: RecheckAppointment Notes: Special payment terms exist, Overdue remindersReduced pred recently to 10mg sid28 days since last zycortalStill drinking a ltoA little more settled at nightThristier than normalBumping into things worse than she was.Maintenance dose of pred is 0.1-0.2mg/kg sid = 1-2mg daily.Na 150K 3.9Cl 112Haematology okRecommend recheck lytes in 1 weekContinue pred 10mg sid another week, then can reduce to 5mg sid.    Vital Signs    Weight: 17.6;       

Reason: phonecallSpoke to Liz Thrift?Hi Linda,I'm glad she is doing better although I don't have a good reason for why she is still disoriented and bumping into things. Perhaps a brain MRI is a good next step? Although see if this continues once she is normokalemic first.The cortate could be causing some night time restlessness. Otherwise it could be cognitive decline, other brain disease etc. I suspect her hypokalemia is iatrogenic from cortate/DOCPWeird that her neutrophils and monocytes are not high. You can definitely consider a reduction in her cortate and your dose suggestion is reasonable but warn the O that we aren't really seeing glucocorticoid excess on her CBC so she might deteriorate with a dose reduction and watch her carefully. Make sure her [K] has normalised with your potassium gluconate supplementationYes - the K supplementation will make interpreting her lytes and subsequent DOCP challenging. If she can be OFF this or on the lowest effective dose, that would be preferable. Alternatively, don't do DOCP and just change to Florinef as that may make dose changes easier. Hope that helps!Kind regards,Dr. Elizabeth ThriftPositive IgG neospora - ideally would retest in 3 weeksStart clindamycin as a precaution 150mg 1.75 tabs bid 4 weeksPosibie IgG for toxo but IgM normal. Could retest IgG in 3 weeks - but this is far less likely and could consider not doing this if cost concerned.Will stop cortate and change to prednisolone as cortate has mineralcorticoid activitiy and not great to use with the DOCP.Start prednisolone at 15mg daily. Stop hypokal.Re-test CBC an lytes in 1 week, and then on 10th March.    Vital Signs    

Liz advised: MDCortateClindamydin 150mg -1.75 Tab daily x 3 weeksDear Colleagues,Please find attached the laboratory results for Raisin Fitz-Gerald. If you have any queries, please do not hesitate to contact me. Kind regards,Dr Lauren Oehlers on behalf of, Dr. Elizabeth ThriftThe Pet SpecialistsReason: Seen at The Pet Specialist for referral/emergency.Patient history attached.    Vital Signs