C10011090 / invoice 10000

Reason: Flat Over Weekend And Off FoodAppointment Notes: Overdue remindersHistory:Presenting for: Patient presented for ongoing lethargy and general malaise since Saturday, with owner reporting the dog appears uncomfortable and not quite herselfHistorical Conditions:- Chronic arthritis - long-standing condition causing discomfort when sitting- Previous skin cancers removed- Weight fluctuations noted (23.6kg in February, 25.6kg in September)Diet:- Good appetite maintained - ate whole chicken last night, first proper meal since Friday- Prefers chicken over tunaV/D/C/S:- No faeces produced on Sunday- No vomiting reportedCurrent Meds:- Anti-inflammatories (Metacam) - recently administered- Other medications given since Saturday (causing sleepiness)Other:- Patient has been sleeping extensively since weekend- Owner notes dog appears sad and uncomfortable- Gradual improvement noted this morning but still concerns presentExamination:Mentation: Appears flat and lethargicWt: Current weight shows slight decrease from previous recordingsT: Not takenMM: Nice and pinkBehavioural: Lethargic, head appears wide, minimal movement, sleeping extensivelyCardiovascular: Heart sounds goodMusculoskeletal: Uncomfortable sitting position due to chronic arthritis, appears uncomfortable in back, reluctant to sit normallyAssessment:Lethargy and malaise - DDx: medication side effects, pain/discomfort, underlying infection, neoplasia (given age and previous skin cancer history). Chronic arthritis complicating assessment of current discomfort.Plan:Diagnostics:- Blood work to check for infection or other abnormalities - results to be available tomorrowNew Meds/Tx:- Buprenorphine injection administered for analgesia - may cause mild sedation- Anti-nausea medication administered - also effective for visceral painAdditional Discussion:- Discussed differential diagnoses including cancer as possibility in older dogs- Plan to monitor response over next 1-2 days- If no improvement by Friday, recommend referral to facility with overnight capabilities for comprehensive workup- Noted potential for doubling up on diagnostics if transferred to emergency clinicClient Comms:- Will call tomorrow with blood work results and check on patient progress- Monitor tonight and tomorrow morning for any changes- Contact clinic if concerns arise- If deterioration by Friday, consider referral for more extensive diagnostics and overnight monitoring    Vital Signs    Weight: 23.2;       Temperature: 38.7;