C10013866 / invoice 10000

Reason: Repeat Bloods CCEHAppointment Notes: Overdue remindersHISTORY:Recheck bloods for elevated ALT. Ongoing management of severe allergies.ALT test performed yesterday was elevated (500). A full blood panel is being performed today for further investigation.History of severe allergies, which are reportedly improving with zenrelia prescribed yesterday. The owner was planning to start a hypoallergenic diet but is now awaiting advice on a liver-specific diet.No previous abdominal ultrasound has been performed.Current meds: zenrelia tablet for allergies.Vaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: Severe skin allergies, elevated ALT.Access to toxins eg. Rodenticide: noneExamination:BAREyes, ears, nose normalOral cavity normal; mod tartar on upper caninesMM pink, moist, CRT 1 secNormal left Apical beat on palpationChest ausc. NormalHeart: Reg rate and rhythm, no murmurs.Lungs: NAD. RR and effort not increased. No adventitious noise on auscultationFemoral pulses strong, synchronous with HRAbdomen palpation: Relaxed and comfortable to palpate. No obvious abnormalities onpalpation; no masses.LN normalNeuro: normalmentation: appropriateCNs intact. menace/ palpebral normal. Facial and nasal sensation and gag normal.Posture/Gait: ambulatory with no evidence of ataxia or paresispostural responses: normal paw placement and hopping in all 4 limbsspinal reflex: normal withdrawal reflex, normal patella reflexs-spinal palpation: no spinal painMusculoskeletal: NormalMovement/ placement WNL.Skin: alopecial along the ventral abdo and limbsAssessment:Vital signs and physical examination are unremarkable. Bloods taken for TAHPPROBLEM LIST:Elevated ALT.Severe allergic dermatitis.ASSESSMENT:Re-presentation for a full blood panel following an elevated ALT result from yesterday. The patient also has a history of severe allergies, which are currently being managed with medication and appear to be improving. Physical examination today is unremarkable. Awaiting full blood results to guide further management, which may include an abdominal ultrasound.TREATMENT:Script provided for Denamarin Continue zenrelia as prescribed for allergies.PLAN:Awaiting blood test results, expected tomorrow.An abdominal ultrasound is the likely next diagnostic step if liver enzymes remain elevated.Home into owner's care.CLIENT COMMUNICATION:Discussed the need for a full blood panel to investigate the previously identified high ALT.Advised that results are expected tomorrow.Informed owner that an abdominal ultrasound may be recommended depending on the blood results. - VIA u/sDiscussed ongoing management of allergies, including continuation of current medication and provision of a script for a liver-specific diet.Rx:	……………Denamarin Liver health Supplement......................Mitte:	……………Medium Dogs 30 Pack..............................Directions:                   Give one tablet ONCE daily 6 REPEATS    Vital Signs    DentalGrade: 2;       BodyScore: 5;