C10010316 / invoice 10000

Reason: Very Lethargic Appointment Notes: Special payment terms exist, Overdue remindersO called earlier 9am Worried about overall poor behavior - not eating, not gone to the toilet, lethargic, no interest in walking, less sleepy, during sleep takes long gaps between breathsRecomm to pop-in today w MPTemp 39.5 HR 108RR 32CRT 2secs, still pink Water intake : via syringe by O this AM Urine normal, no poo since yesterday AM Offered all her favorite food but hasnt shown any interest Not wanting to walk, low energy but still reactive and aware of surroundingHistory: --- 10/03/2026 11:53:01 PM3: Yesterday started seeming off. Stopped using her back left leg from yesterday afternoon Didn't want to eat all- offered her some turkey- ate a bit, but that is the only thing she wants to eatHave syringe fed her water. Yesterday and today she has been very lethargic and out of it. Yesterday gave her vetoryl and gaba. Hasn't had gabapentin in while- had this for the first time in a while yesterday because worried she was in pain. Had vetoryl once in the morning yesterday and day before, but hasn't had it for 2 days before that because had some runny poos. Never been able to get her consistnetly on the vetoryl because had intermittent diarrhoea/vomiting Examination:  quiet, lying in a bed laterally recumbent, responsiveEyes: bilat nuclear sclerosisEars NADMouth and teeth: gums are pink, tacky, crt <2 secLns WNLThoracic cavity: increased respiratory rate and effort- some abdominal effort. Normal heart sounds, but increased lung sounds- can hear some crackles/raspiness, but feel this sounds more upper respIntegument: multiple warts, skin tent delayed return to normal Abdo palp: abdomen feels distended and bloated, uncomfortable on palpation. No fluid wave Musculoskeletal: struggling to stand, right hind limb no deep pain or proprioception, unable to use this- just limp Assessment: sudden downhill turn. Ddx: addisonian crisis, infection (aspiration pneumonia? Other infection??), tumour, TIAOn discussion with owner Priscilla feels that Ninja's sudden turn for worse might mean it is her time to say goodbye- feels her body is failing her. Does not want to put NInja through a lot of investigation- happy to do some baseline checks to make sure nothing simple and fixable- recc lytes and chest radPriscilla consented to thisTreatment: 2x lateral chest radiographs taken- heart size normal, no obvious metastases/consolidation of lungs. Can see abdomen on chest rads- lots of faeces in colon. Blood collected for lytes Placed u/s probe on abdomen- no obvious free fluidRight upper quadrant of abdomen found 4cm irregular mass- cannot find kidneyLaboratory: Na:K ratio 42Cl mildly highAssessment: tumour in right side abdomen- tumour of kidney vs other??Not addisonian crisisNo evidence of aspiration pneumonia. Prscilla not interseted in further investigation. Wants to do home euth. Requested palliative meds to give 1-2 days at home. Advised can try pain meds, appetite stimulants and some sub cut fluids as mildly dehydrated. Priscilla happy with this Treatment:  100ml hartmanns given sc Plan: metacm SIDParacetamol q8hMirtazapine SID as needed for appetite stimulation Home euth in near futureClient Communication: --- 10/03/2026 15:31:35 PM3:Ninja is panting quite a lot, and seems a bit unsettled. Breathing seems labouredHas the meds when left appointment today at around 1pm. Has had lots of turkey and ham, but otherwise not much betterWants to know if should book for home euth tonight instead of waiting for tomorrow. Advised really should have the effect of meds working now 2 hours after giving, if breathing laboured and she does not seem more comfortable, would not recc waiting overnight. Priscilla thankful for advice    Vital Signs