C10030919 / invoice 10000

Reason: B12 Injection. Show Owner How To Do LD ApprovedAppointment Notes: injection ok'd by Lauren to be done by nurse. kh]Talk to Courtney if there is a question re caseGave 0.8ml b12 injection sc, took owner into tx room and went through how to give a injection. Rosie was very good for her injection, wouldnt take treats.Explained to the owner sometimes the hand movements of giving a injection is the hardest part, gave 1ml syringe to practice at home. He    Vital Signs    

Reason: Check Skin, Discuss MedsAppointment Notes: Overdue remindersHx: was not eating lyka kangaroo owner thinks as was putting prokolin on it. Tried fish and she did not like it. Gave pork/ rice last night and ate well- recommend stop pork most likely too fatty. Watery diarrhoea yesterday. Alternating formed and diarrhoea within same poo.No UTI signs. Not drinking excessively. No vomiting. Skin:Shaking earsNibbling front paws. PE: weight stable. BAR, euhydrated, HR 160, rr pant, temp. 38.6Abdomen comfortableMoist erythema ventral front pawsMod wax AUCytology: SBI- marked neutr ventral feet, some yeast. Ears marked yeast AU. Could not get urine free-catch again. Tx: cleaned ears otoflush. Plan: b12 injection nurse on sat (0.8mls SQ b12- can you show owner how to give). Booked in with another vet for bloods sat. Keryn would like continuity of care. Will wait to see AS next Tues for albumin and just B12 with nurse on sat. Will be then coming in twice weekly. Keryn wants to learn to do b12 injections herself at home. Amoxyclav 20mg/kg BID 7 days. Hold pred for now. Discussed endoscopic biopsy again. Explained r/o cancer/ diet responsive/ IBD. May not get answer sometimes. More difficult if already on pred. Keryn declined. Come in sooner if lethargic/ not eating. Dermotic BID 10 days AU. Remain on lyka kangaroo for now. Explained we may end up trying other diet too eg purina HA biscuits. **took pred off previous bill. Had not gone through insurance yet. Will have to rebill if dispense next Tues.    Vital Signs    Weight: 20.3;       

Reason: Blood TestAppointment Notes: khHistory:Chronic D+ with hypoprotaeinamia (improving). Albumin 18 --> 20 --> 22Low B12, and high folate. Started B12 injection 07/03Managed with strict low fat digestible diet. On prokolin. Off her food. Probably eating about 10% of foodDiet: kangaroo lyka, eating more of save a life kangaroo dry Not drinking much, not urinating muchLethargic. No V+Formed faeces. Quite flatulent. Medications: b12 injection, pro-kolin Physical exam:BARMM pink moist, CRT 1-2s Muffled heart sounds? Intermittent clear beatsWeight loss 600g since last visit. Laboratory:Albumin 18 --> 20 --> 22 --> 21 Plan:First time albumin has fallen. Indicates futher action required. O has declined intestinal biopsy. Start pred 20mg BID x 2 weeks, then reduce to SID x 2 weeks, then 10mg SID x 2 weeks, then 10mg eod x 2 weeks. Ongoing weekly B12 and pro-kolin. Check albumin at each B12 injection (weekly) Ongoing supportive care ok - mirtazipine, cerenia, pro-kolin. Strict dietary management as prev--- 11/03/2026 19:05:52 AS1:Called O to discuss starting pred Still not eating well. Has been itchy recently. Hx of atopy As concerned for possible pyoderma + otitis externa - would prefer we check this prior to starting pred Booked in for consult 12:15am with LD PLEASE TRY GET URINEIf skin is clear then cleared to start pred. Discussed intestinal biopsy with O today again. May come with questions tomorrow. LD - I have created a pred tapering schedule in the disharge statement attached.    Vital Signs    Weight: 20.0;