C10010945 / invoice 10000

Reason: LB - Lethargic & Flat - Possibly In Pain?Appointment Notes: * Still eating & drinking, but not herself at all. (JP)History: Similar clinical signs to this time last yearShe has been very well in the past 12 monthsWas very deaf after the last incident a year agoShe has lost 2kg over the past year.She is eating wellDiet: Hills dry biome with poached chicken, very sensitive GITSince Saturday her behaviour has been different - looks sad, not moving well around the houseSunday perked up and was back to normal, today went for a walk and enjoyed the walkToday she tried to jump up on the bed and missed - this is very unusualNo VomitingNormal stoolEats bid most of the time, not as eating as much , grazing a bit more than she used toExamine:HR:120, no audible murmur, strong synchronous pulseRR:Temp:38.9BCS:4/9, has lost ++ weight - concerning...Eyes:nadEars:nadDental score:4, tartar on all teethMM/CRT : pink/moistLN:nadSkin/Coat:wart virus, multiple small wartsFleas seen: NAbdomen:  nad, soft, non painful, no obvious mass palpatedLimbs/Gait: very painful on extension of left shoulder joint, pain in neck when turning head to the left USG - 1.018Dipstick BLD/HGB: 1+Protein: tracePH: 6Assessment: Painful shoulder and neck. Weight loss a major concern Treatment: Panadol 0.7ml bid, gabapentin 100mg sid at night and may repeat in the morning if not too sedating. Plan: Bloods first then abdoU/S and chest rads, looking for causes of weight loss.  Estimates given for any procedures discussed.Consent forms signed for all admissions/procedures.    Vital Signs    Weight: 6.6;