C10017187 / invoice 10000

Hx- O reports diarrhoea has resolved. Has been going well overall. energenic, eating and gaining weightCurrent meds: ondanseton 8mg TID, TXA 500mg 1 and 1/4 tabs BID, cerenia 80mg as needed, apoquel 16mg SIDCEBARWell hydratedCVS: MM pink CRT <2 HR: 100bpm normal rate and rhythmAbdo palp: can feel the tumour forming (initially 7cm at the origin of the spleen), not painful on palpation and no FF waveTemp: 38.6No ext lymphadenopathyChest: clearA- fit for CCNU admin'dP- CCNU 80mg given orally. chased down with water and foodprevomax 1mg/kg given  SQ

Hx- O reports good response to scourban, losec, carafate and diet change. CEBARWell hydratedCVS: MM pink CRT <2 Panty with normal rate and effortAbdo palp: still cannot palpate the tumour. no FF waveTemp: 38.6Integument: WNLSNo ext lymphadenoapthyA- post hosp from diarrhoea due to doxorubicin is improvingP- no CBC today as it was perfect 5 days ago and mickle is clinically improvingapoquel dispensed, chornic allergies. stableCCNU chemo due next week on monday

Went to MASH last night at 11am due to hamehorragic diarrhoea. suspect doxorubin related as was given on monday last week. has been inappetiant but she is bright. no vomiting. maropitant was given at 3am last night. returned for RVLOC:BARHR: 112bpmmm: pink < 2s Temp:38.6Urine: ++Defaecation: mild haemorrhagic dirrahoreaVomit: -Appetite: poor but did eat mid afteroon, she likes to be handfed.CLINICAL EXAM: POCUS: no FF, did assess the 7cm tumour in the region were the spleen was removed (seeded tumour, suspect on the omentum) and she was uncomfortable with it. but on palpation she was ok. IVFT volume: @ 135ml/hrLab: CBC and biochem, no significant changes. neurphils 3.51 x 10^9 and no anemia.A - HGE post doxorubicin admin'dP - maropitant still active post MASH visit. admit for IVFT at 1.5x maintance to help support her. Treatment:Scourban liquid (antidiarrhoea): Give 25ml orally twice daily until normal faeces develop. Starting 8am on Sunday morningLosec 20mg tablets (gastrointestinal protectant): Give 2 tablets ONCE daily. Start Sunday afternoon pleaseCarafate 1gm tablets (gastrointestinal protectant). Give 1 tablet twice daily disolved in a syringe of water. Start Sunday morning pleaseTXA tablets (the one with label with my handwriting!) 1 and 1/4 tablets twice daily. Next due Sunday morningOndansetron 8mg. GIve 1 tablet once or twice daily.Once we have given the above medication (directly into the mouth and not in food), she ate a whole can of Royal Canin Puppy gastrointestinal food with enthusiasm and was asking for more. We have dispensed mirtazepine 30mg tablets (give 1 tablet ONCE daily) and gabapentin 100mg capsules (give 2 capsules twice daily) for you to start Sunday morning if appetite continues to be an issue at home. The gabapentin is for tummy pain (which we don't believe she has continiously unless we are putting pressure on the tumour) and mirtazepine for appetite stimulation. Both these drugs can cause sedation, and together they can cause a heavier sedation. If you need to use something for appetite stumulation for Sunday, start with mirtazepine in the morning first. Then if no profound sedation, start gabapentin in the afternoon.Overall, all the drugs we have dispensed can be given together, it is just the mirtzaepine and gabapentin causing sedation. Recommendations:Sending home with some Hills ID digestive care and puppy gastrointestinal cans. Review on Monday still please :)