C10012205 / invoice 10000

Seems to be tolerating medication.  Lip lesion is coming off. every now and then will moan at home, but seems comfortable. Admitted for soundiagnosis ultrasound.Lost weight again, 700g. Trim nails.  TAHP + sound + radiographs today, estimate given to O. Discussed dermatology referral.  Medications: apoquel 16 BID magic mouthwash: 30mL lignocaine 30mL water for injection over weekendCarafate tablets Ondansetron 8mg BIDDoxycycline 5mg/kg bid for immunomodulatory effectPentoxifylline 400mg bid for immunomodulatory effect and to reduce vasculitis itself, recommend continue at least 12w and taper to sid before stopping, watching for relapseContinue macrolone 40mg SID, now reduced to 30mg.  Sound + xrayPremedication: Buthorphanol 0.2mg/kg IV Sound report: Sonographic Findings / ConclusionDiffusely hyperechoic hepatic parenchyma, preserving adequate size, margins and architecture. Ddx: vacuolar hepatopathy, hepatitis,emerging infiltrative disease (less likely).Moderately dilated pancreatic duct, with the pancreas preserving adequate thickness, margins and architecture. Ddx: incidental finding,pancreatitis (less likely).Comments / RecommendationsToday’s abdominal ultrasound was largely unremarkable.Ultrasound guided fine needle biopsies of the liver may be considered; however, please note that for some conditions, histopathology may bemore reliable than cytology in diagnosing hepatobiliary disease. Moreover, in this patient, the sonographic appearance of the liver is most likely consistent with benign processes such as vacuolar hepatopathy.X-rays:  lungs WNL, no masses identified, normal lung pattern with end of vessels visualised.  Liver past the costal arch DDx: hepatomegaly. Plan:Trimmed off necrotic lip lesion (reduced smell immediately). Call back TAHPDermatologist referral suggested - Melbourne Veterinary Specialist Centre in Glen Waverley as there is an internal medicine team as well.  Order in cyclosporin 100mg, 2 tablets SID for 6 weeks. Can increase if required.  (wrote to do for AO and EB).      Vital Signs    Weight: 24.8;       MMColour: Pink;       Skin: Abnormal (healing biopsy sites, dark and discoloured at centre. );       Observation: Abnormal (sloughing L lip ulceration/lesion. );       Temperature: 39.4;       HeartRate: 100;       CRT: 1-2;