C10013569 / invoice 20000

INSURANCE HXInitial Assessment > bloods for monitoring -- extra invue to accurately read platelet countSuspected cause > acute lymphoblastic leukemiaDate of first clinical signs > 1-3 months agoAny other conditions / treatments > none    Vital Signs    

Appointment Notes:Subjective: Presenting for rpt CBC + ALT 2 weeks after starting chlorambucil + predO reports going very well. No negative side effects, breathing improved, no further swelling of the limbsEDDU normal, no v/dObjective: BAR, nice girlHR/PR/CV: 172bpm, no murmur or arrhythmia, pulses strongMM/CRT/Hydration: mm pink, slightly tacky, crt <2s, normal skin turgorRESP/RR: normal rate and effort, resp rate quicker throughout the consult, increased lung sounds noted bilaterally but less than previousTemp: 38.3CGIT/UG: soft, comfortable palpationSkin/Ears: nadM/S: ambulating fineEyes: clearDental: g1-2/4Lymph Nodes: all WNL- RIGHT popliteal LN that was previously enlarged and firm now small, round pea sized, almost unpalpableBCS: 5/9 - 30g weight loss, possible scale variationLaboratory:PLT >150x10^9 NEU 19.67x10^9/L (2.30 - 10.29) HALT 78 (12 - 130)Assessment: Clinically going very wellLymphocyte count dropping on bloods + PLT, neutrophil count and ALT levels adequate to continue on current chemo protocolTreatment: Chlorambucil 2mg EOD Prednisolone 20mg half tab (10mg total) EODPlan: Recheck CBC + ALT in 2 weeks, if all normal then continue on above dosage until D42 (then pred drops to 1/4 tab EOD)*need to reprint protocol for Os, previous written protocol had incorrect dosage for D28*____________________________INSURANCE HXInitial Assessment > bloods for monitoringSuspected cause > acute lymphoblastic leukemiaDate of first clinical signs > 1-3 months agoAny other conditions / treatments > none    Vital Signs    Weight: 4.87;       Temperature: 38.2;       

Appointment Notes: discuss chemo + CBC + biochemSubjective: Presenting for recheck and discussion of chemo protocolO reports no change since last visit. Going ok at home, only very occasional wheezingO notes intermittent swelling of the LFL, doesn't seem to be bothering herHave ordered chlorambucil from terry white, collecting MondayTrialled neocort over the neck but Kasumi hates thisEDDU normal, no v/dObjective: BAR, good girl for allHR/PR/CV: 180, no murmur, pulses strongMM/CRT/Hydration: mm pm, crt <2s, normal skin turgorRESP/RR: slight increased noise L ventral lung lobe, quick RR but likely due to stressTemp: NTGIT/UG: soft, comfortable on abdo palpSkin/Ears: scabbing along shaved patches on neck, otherwise nadM/S: ambulating wellEyes: clearDental: g1/4Lymph Nodes: RIGHT popliteal LN enlarged, same size as previous, otherwise nadBCS: 5/9Assessment: Clinically stableTreatment: Start on chlorambucil 2mg SID PO + pred 10mg SID PO for next 2 weeksDiscussion with owners:Printed chemo protocol and discussed side effects of chlorambucil, pred, monitoring blood tests fortnightly etc. O is comfortable going ahead and aware of the risksPlan: SYL FUC in 1 weekMonitor for signs of lethargy, inappetence, v/dRpt CBC + ALT in 2 weeks    Vital Signs    Weight: 4.9;