C10011777 / invoice 10000

check up and blood test 
Liver enzymes up at ER a month ago

Subjective:
- Follow-up for elevated liver enzymes; bloods at emergency vet approximately one month ago showed liver enzymes approximately 10 times normal
- Liver meds for one month, now finished
- Collapsing episode approximately one month ago; incidental finding of elevated liver enzymes; emergency vet optimistic
- Owner suspects collapse related to worsening hindlimb weakness; possible fall onto back
- No seizure activity confirmed; recovered immediately
- Weight loss: 22.5 kg previously, now 19.7 kg; spine now prominent
- Diet changed to human-grade chicken mince with rice, broccoli, pumpkin; stopped pet chicken mince due to copper content
- Increased water intake noted
- Urine very yellow and concentrated
- No vomiting since small bile vomit approximately one month ago
- Still eating and hungry
- Developing separation anxiety
- Gabapentin given intermittently (approximately 6 times in last month); caused sedation initially, less so recently
- Stopped all supplements including hemp seed oil due to liver concerns

Past Medical History:
- Previous elevated liver enzymes (May) - not concerning at the time
- Chronic hindlimb weakness/lameness - progressively worsening
- Previous weight approximately 20-20.3 kg at times

Objective:
- BAR
- Normal heart and lung sounds, HR: 114
- No evidence of jaundice
- Weight: 19.7 kg
- Temp: 38.8
- Abdominal palp: rotund, no other abnormalities noted
- BCS 2.5/5
- Dental grade 2.5/4
- MM:pm crt 2s
- Right hindlimb lameness
- Muscle atrophy RHL.
Assessment:
- Elevated liver enzymes - repeat bloods to assess improvement

Plan:
- Consider ongoing gabapentin twice daily for neuropathic pain if liver function improved; assess after at least one month
- Balance gabapentin dosing with sedation side effects
- Monitor weight; do not want further weight loss