C10010338 / invoice 10000

Reason: Bloods - Repeat CBC EG Appointment Notes: Overdue remindersHistory: Doing better since yesterday. Limping a little LHL, previous CrCl injury, seems better today. No haematuriaExamination: BAR, mm pale pink/moistGingival petaechiae resolvedNo petaechiea/ecchymoses anywhere elsePlan:Blood sent for CBC (EDTA and smear)Gave script for mycophenolate and cerenia    Vital Signs    

Appointment Notes: Overdue remindersPlan: TV spoke at length with AD from VetsnorthAD worried about sensivity of Mala to preds becasue of breed Advised keeping on cernia as long as needed to prevent nausea and v+ - worried that excessive v+ will trigger bleeding AD recommended mycofenolate instead to imuran.  She said Imuran is a good choice but we won't be able to wean Mala off preds altogether, we will need to keep her on preds, just at a lower dose.Mycofenolate has been shown to be able to be used on its own and wean off preds completely - in most cases.  If platlet count stays stable.  This is the only immunosuppressant that has been shown to maintain IMTP on its own. AD is worried about impact of preds on Mala.    We will need to keep Mala on preds for at least 4 weeks regardless, but we may be able to start weaning sooner - if stable.  Client Communication: TV called Georgia and explained above.  Plan: 1.  Cerenia as needed, given script as well as tablets 2.  Script for mycofenolate - start at 360mg total (10-12mg/kg) BID - script given - use for 3 months - if platelet count stable start reducing - but can go faster than a wean off pred - will reduce by half every few weeks.  3.  Monitor CBC as previously planned Scripts:Request for Supply of Prescription MedicationSupplier:Date:                            09/03/2026Client Name:              Miss  Georgia  Uebergang                                      Unit 45/ 1-3 Delmar Parade                                      DEE WHY  NSW  2099Patient Name:          Mala  Patient Number:       8078771Species:                    dogGender:                     Female DOB:                          12/03/2018Visit Number:            28485275For Schedule 8 scripts, the prescriber must rewrite all mandatory particulars in their own handwriting.Please supply the following to Miss Uebergang for the express purpose of treating MalaRx:	Mycofenolate 360mg tablets Mitte:	1 bottle 120 tabletsDirections:                   Please give 1 tablet twice daily (12 hours apart)                                          …………….…..………………………………………….4 REPEATSKEEP OUT OF REACH OF CHILDRENFOR ANIMAL TREATMENT ONLYNo. of Items: 1Vet Signature: ……………………………………….Vet Name: Dr Trudie Vestey< NSW V8242 Request for Supply of Prescription MedicationSupplier:Date:                            09/03/2026Client Name:              Miss  Georgia  Uebergang                                      Unit 45/ 1-3 Delmar Parade                                      DEE WHY  NSW  2099Patient Name:          Mala  Patient Number:       8078771Species:                    dogGender:                     Female DOB:                          12/03/2018Visit Number:            28485275For Schedule 8 scripts, the prescriber must rewrite all mandatory particulars in their own handwriting.Please supply the following to Miss Uebergang for the express purpose of treating MalaRx:	Cerenia 160mg tablets  Mitte:	1 box, 4 tabsDirections:                   Please give ½ (half) tablet ONCE daily                                           …………….…..………………………………………….4 REPEATSKEEP OUT OF REACH OF CHILDRENFOR ANIMAL TREATMENT ONLYNo. of Items: 1Vet Signature: ……………………………………….Vet Name: Dr Trudie Vestey,  NSW V8242    Vital Signs