C10013301 / invoice 10000

Reason: Pls Dispense Meds This Morning MM Appointment Notes: needing late this morning if possible please + vsos called asking us to dispense palexia script and loxicom pls > text both O's when ready for collectionKS Palexia script written for 50mg SR tablets x 28 at 1 tab BID with one repeat. Handwritten only, printer not working.Also script ondansetron 8mg x 10 with 6 rpts at 1 wafer BID    Vital Signs    

Reason: Abdominal Fluid Drain - CTHistory:Both Os brought dog in Referred to VSOS after last visit 4d ago Dx with carcinomatosis with metastasis to multiple sites On palliative management now Drained 1L of fluid from abdomen Has been good since visit to VSOS Still keen to go for walks A bit tired the first few days after discharge But has been better this AM Ate a dental stick this AM Didn't want to play with toy last night Itching a bit on his abdomen after clip at VSOS Current meds: - Previcox 57mg 1T PO SID - Maropitant 24mg 1T PO SID - Tapentadol 50mg 1T PO BID - Paracetamol 500mg 1/2T PO BID Difficult to get paracetamol in now as hates tablets Wants to change over to liquid where possible Examination:BAR. Wagging tail Temp 38.1 G3/6 systolic heart murmur PMI left apex. No arrhythmiasPanting but clear lung sounds, normal resp effortFemoral pulses SS Oral exam - **snapped** - o opened lower lip to check, MM pinkAbdo - bloated, palpable fluid wave. Doesn't tolerate deep palp, tried to snap againMSK - ambulatory x4 Ultrasound probe on Free fluid++ present Drained 650ml of haemorrhagic effusion from RHS Some fluid pockets still present after drainage (but much better than before)- but left as took a long time to drain, and O also said specialist advised to not do full drainage. Assessment:Ascites reforming after recent drainage Poor prognosis with carcinomatosis and metastasis STO - o aware of QOL and longterm outcome. Still thinks dog getting along well with routine, and QOL still present- but has spoken to RYP and aware of euthanasia. Aware fluid has filled up at quick rate, and if not euthanasing soon in next few weeks then will need to come in for abdominocentesis at least 1x a week to provide comfort. Plan:Repeat abdominocentesis in a week - earlier if affecting dog/concerns Flamazine onto affected abdominal skin BID 1-2w until skin heals over Continue palexia and maropitant as prescribedChanged over meds to liquid as below: - Panadol childrens liquid 48mg/ml 4ml PO BID - Loxicom 0.1mg/kg 13.5kg BW mark PO SID If worsening/concerns to bring in for earlier reassessment O aware of euthanasia if QOL deteriorating    Vital Signs    Weight: 13.40;       MMColour: Pink;       HeartRate: 120;       Temperature: 38.1;