C10016654 / invoice 10000

SUBJECTIVE: concerns re lethargy episodes
DDUE all ok
episodes of licking air and also zoning out 
known heart mumrumr, under cardiologist
normal activity other times 
previous history of suspected anaphylaxis collapse episode but no cause identified

OBJECTIVE:
NAD on PE today
oral cavity, missing teeth in upper arcades bilaterally, had deciduous teeth retained as young dog
HR 100, HM g2-3 
RR 28 
abdo- NAD
wt 2.9 kg 
BCS WNL
neurology WNL today, gait normal, mentation normal, postural reflexes normal, PLR and facial responses all WNL

ASSESSMENT:concerns re episodes of lethargy and licking behaviour which is episodic

PLAN:
referral for neurological work up vs internal medicine 

COMMUNICATION:
referral to U Melb Neuro team

phone call with NBH
Stormi is eating and drinking but leaving morning meals and only eating at dinner
mucoid covering to formed stools 
has had one episode of holding up paw and hiding recently, not sure the cause 
otherwise behaviour has been normal
still very concerned about the cause of anaphylaxis with low access to insects in the apartment 

recommend collecting pro- kolin from Port Phillip Animal Hospital - pro kolin is an over the counter medication so should be able to pop in and collect

been well since last visit to CARE with suspect anaphylaxis

QAR, very sweet
mm pm crt <2
HR 126bpm, gr 3/6 hm. normal rhythm, strong synchronous femoral pulse
normal resp effort and bv sounds
abdo soft comfortable

mildly elevated ALT (216 today, 797 on 31/1)
recheck ALT in a week
recommend yearly echo

O very anxious about his heart disease. advised still can have good QOL but will have shortened life span. O asked how long the life span would be, advised heart disease can be unpredictable but can live relatively long life if clinical signs well controlled.