C10028650 / invoice 10000

History:BIB {Clare} . No current concerns. Fasted overnight. Current conditions: LA enlarged on CT scan that was used to investigate LHL Limping.Current medications: Meloxicam 6kg dose PO SID and 40mg gab BID. Last meloxicam was wednesday, last gaba was lst night. Has been fasted since 1.10am.O mentioned that when she got home on wednesday from work Archie seemed a bit uncoordinated on his feet. 2hrs after O gave him his gabapentin and it seemed like he got up too quickly and stumbled? O thinks that maybe cos he's feeling good that he's been overdoing it with his back legs. O is interested in physio- so will email physio places to O.RRR has been around 22-24. Can be around 28 or so but thats when he's not totally resting.Today around 12pm he had 3-4 episodes of short 10seconds of coughing. O thinks maybe its allergies as his ears were a bit hot the last few days which can happen when he's itchy/allergic. O feels that whenever he coughs, it takes it out of him a bit and he gets quite tired for the next day or so.Examination:NAD on clinical examMM p crt <2sHR 200- no murmur detectedHR 24Treatment:Catheter: 22g R cephalicSedative/s:Oxygen supplementation: NProcedure Details: 22g cath in L cephalicAlfaxan titred to effectVIMs echo:Restrictive cardiomyopathy substage B2- full report to follow.3 view thoracic x-rays taken.Enlarged cardiac silhouetteMild bronchial pattern seen on the R lateral radiograph with the cranial lung fields.Total Procedure time: 15 minsMediations administered: Alfaxan IVOther notes: Plan:Ongoing medications: To start on clopidogrel 18.75mg POS SIDDischarge information handout given & discussed.Revisit due: 2-3 wksNote; Archie also has a pulmonary nodule which ideally is to be re-CT-ed in 2-3 mths.Prior to that, ideally start him in 2mg/kg BID of frusemide for the week leading up to the scan.Then ARC can echo him and CT on the same day.

Reason: Breathing funny?Hx: Presented by ClareArchie had his CT scan and results came back on the 2/4 - it was found that he had an enlarged LA with a small pulmonary nodule. Next step would be echo.Since then O feels that Archie has been breathing a bit more rapidly but has counting his RRR and its been 22-24.He did a small cough this morning as well but not as long as he usually does. O has got the dehumidifier going in the house so unsure if that's affecting Archie's coughing.Is still eating and drinking normally, no v/d. Maybe a bit sluggish to get out of bed in the mornings but it has been colder the last few days.No more obvious lameness/twitching on LHL.Current meds:1) meloxicam 6kg dose PO SID2) 50mg gaba BID PO- O would like to see if we can reduce it.Ex:BAR, nice catMm p crt <2sTeeth G1HR 184- no murmur auscultatedRR 32- normal breathing pattern noted, no obvious crackles or wheezes notedIntegument goodLNs NADAbdo palp NADBCS 7/9- stableAssessement:Enlarged LA on CT scan3mm pulmonary nodulePlan:Booked in for echo + chest rads next friday- pending that, will know more about prognosisCommunication:discussed with O to count his RRR daily when he's totally asleep- and we're looking for a trend.So if he's consistently in the 30s, then let us know. It has been a bit humid the last few days so that could increase his RRR. Otherwise, he's still EDDU, no v/d- okay to wait for echo next fri.With regards to back leg- suspect ST injury of some sort- ok to continue on meloxicam, okay to try and reduce gabapentin to 40mg BID PO for a week and if going well, then reduce to 30mg BID PO.

Coughing fit this morning, usually intermittent coughing that has sometimes lined up with asthma.Breathing has been quicker with some effort on and off. Eating well.