Professional Documents
Culture Documents
Client Communication
8/28/2017
Client Communication
Time: 5p
Discussion: O called and requested records be sent to jasonprado@live.com. O said they will be in TX for the next couple
of months so she is going to find a vet there.
Pending DVM approval.
Initials: vj
8/29/17 8:40a Approved per Dr. Larson. Emailed and received okay. vj
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Client Communication
8/11/2017
2 PM- LMOM for owner to call us back to let us know how Lucy is doing and to make sure they got our message last week.
I'm hoping some of the loose stool is starting to clear on the proviable, but call and let us know. Called number
832-231-5124. KL
-411pm- O cb and said that he got our message. P seems to be doing better and gaining weight back. E/d OK, no D+ and
has good energy. Let O know thats good. I will give the doctor the update and if she has any additional questions, will give
him a cb on Monday. O said OK, thank you. JW.
Client Communication
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
8/8/2017
5:30 PM-- Called 832-231-5124 - rang twice and no answer and no machine. Will try again tomorrow.
KL
Client Communication
8/5/2017
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
2 PM- Called owner on 8322315124- LMOM for owner to call back Monday to go over results of labwork- things are
looking better, but there are still some abnormalities- her liver enzymes are back to normal but her she does still have some
anemia. Would like to see how she is doing, if the proviable is helping with the stool any yet, etc. Please call back Monday.
KL
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
K/uL may
indicate an inadequate bone marrow response. Serial
monitoring of the
erythrogram and reticulocyte count may be useful to evaluate
bone
marrow responsiveness over time.
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
SDMA 12 ug/dL 0 - 14
Ascn: 7901224406
RE: 281 HEMOLYSIS INDEX N
Index of N, 1+, 2+ exhibits no significant effect on
chemistry values.
RE: 282 LIPEMIA INDEX N
Index of N, 1+, 2+ exhibits no significant effect on
chemistry values.
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Recheck _Here for recheck. She is doing better, she has gained weight. No v/d or c/s. E/d is normal and energy level
is back to normal. She is still on the Denamarin and she finished the Clavamox.
Soft formed stools, flatulent, mm-pale/tacky, BCS 3/9_
Recommendations
Discussed soft stool and flatulence may be results of bacterial imbalance due to abx or original illness not resolved.
Adult screen with spec cPL to Idexx - will call with results
Consider testing for addisons, cobalmin/folate?, and consider need for prescription diet after bldwk review, but would not
expect addisons to change liver function per bile acids results.
Recommend ultrasound if bldwk values not improved or resolved.
tech initials: ja
Doctor: Monica Kimber, DVM
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Client Communication
7/18/2017
How is P doing? Ps lepto test came back negative which is really good. The bile acids were moderately elevated
which is consistent with some liver dysfunction but not bad enough to be a shunt. Would need ultrasound to confirm that,
can refer to imaging specialist for that. If P is doing good/seems to be improving, recommend continuing on medication and
rechecking in 2 weeks.
SW
4:10pm Called and lmom stating above info. Asked O to give us a call back to let us know they got our message.
ja
Client Communication
7/14/2017
Client Communication Here for a consultation, & drop off for bile acids testing.
Time: 10:00
Discussed with O about Ps bloodwork. Repeated previous client communication discussion of recommendations
1. Bile acids test. Explained that this is a liver function test and will help us rule in/out if P has an underlying genetic
condition called a liver shunt. Since P is younger, this is a possibility, but not very high chance.
2. Referral to imaging specialist in Gilbert for ultrasound. Recommend this to help get better idea of what exactly is going
on in liver.
3. Recommend starting on abx and liver protectant (Denamarin), in order to treat any possible infection. Would recommend
doing this no matter what follow-up diagnostics want to pursue.
4. Lastly would recommend checking for disease called leptospirosis. It affects the liver and is bad because it can actually
be transmitted to humans so we would be checking for it just to be safe.
O asked where would recommend starting cost-wise. Recommend abx and denamarin, then bile acids test. Explained
concern for leptospirosis, would be good to have that test done as well since it is a human health hazard. Depending on the
answers from the followup diagnostics, may need to pursue further imaging at specialist. O would like to do bile acids and
lepto PCR today. P has been fasted for 12 hrs.
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Discussion: Bile acids pre- drawn at 10:35 am, also drew blood for the Leptospira real PCR test- told owner it takes 1-3
days for results to come back- will call when they come in.
Feed Science Diet Low Fat I/D
Post bile acids drawn at 12:35 pm- Idexx pending- will call owner with results
TGH- Clavamox & Denamarin- See Rx
Also let O know that valley fever titer was negative.
Initials: FR
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
relative severity of
liver disease. Additional diagnostics (e.g. ultrasound
and/or liver biopsy)
are recommended to further classify the disease process.
Note: If the serum bilirubin concentration is elevated or
the animal is
icteric, there is little additional diagnostic value in
performing a bile acids
test.
RESULT VERIFIED BY REPEAT ANALYSIS
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Client Communication
7/13/2017
Client Communication
Time:
10:31am
Discussion:
Called and tto about Ps bloodwork resutls. Explained that Dr Larson is out of town and so I will be taking over Ps case for
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
her. Went over elevations in liver enzymes and anemia. Explained that we are worried about Ps liver, possibly an infection.
Couple options for next steps,
1. Bile acids test. Explained that this is a liver function test and will help us rule in/out if P has an underlying genetic
condition called a liver shunt. Since P is younger, this is a possibility, but not very high chance.
2. Referral to imaging specialist in Gilbert for ultrasound. Recommend this to help get better idea of what exactly is going
on in liver.
3. Recommend starting on abx and liver protectant (Denamarin), in order to treat any possible infection. Would recommend
doing this no matter what follow-up diagnostics want to pursue.
4. Lastly would recommend checking for disease called leptospirosis. It affects the liver and is bad because it can actually
be transmitted to humans so we would be checking for it just to be safe.
O asked if these could be done in one test. Let O know we could add on the Lepto to the bloodwork already sent to the lab,
but the bile acids are a separate test. We fast them for 12 hrs, then take a sample, then feed them, then four hours later
take another sample. This helps evaluate if the liver is able to clear the byproducts of food breakdown and assess the liver
function. O asked if we could email him this and then if he could come down with P and go over it and decide what to do.
Told O that was fine, can definitely do that.
Email: jasonprado@live.com
Scheduled for consultation tomorrow at 9: 45 am
Initials: SW
SUBJECTIVE/HISTORY
Here for exam. Owner said that he has noticed wt loss with in the last 3 weeks. Owner went out of town and came
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
back and noticed the difference. Still e/d-good, no v/c/s. A little bit of soft stool. They did change her diet, its still puppy food.
Decrease in energy. Is current on vx through vet in CA, owner didnt bring paperwork. Owner said that he doesnt think she
had a stool check done. Had a heat cycle in April. __
Diet: blue buffalo puppy
Current Medications/Supplements: none
Vx Hx: current on vx through vet in CA-owner didnt bring paperwork.
Attitude: _QAR_
Technician's initials: {ML}
OBJECTIVE/EXAM
T: 101.4 P: 160 R: pant. MM: pink CRT: <2
BCS: _4/9_
Oral: wnl
Ophthalmic: wnl
Otoscopic: wnl
Coat/Skin: wnl
Respiratory: wnl
Cardiovascular: wnl
Abdominal: wnl
M/S: wnl
Neuro: wnl
Lymph nodes: wnl
Other: __
ASSESSMENT
_Weight loss/slight lethargy- intestinal parasites, bacterial, fungal, viral, rickettsial, renal, open_
Prognosis: fair-good
PLAN
Discussed with owner that overall pet does seem a bit more relaxed than typical corgi pup. And if she has been
losing a bit of weight there are concerns. Is possible she could have intestinal parasites- asked owner if her stools are
loose- per owner they are occassionally a little loose but they recently changed her diet so think it is from that. Recommend
checking a fecal and checking bloodwork. Discussed VF, TF, intestinal parasites, or other possible causes of weight loss.
HW4DX- negative all four
Fecal and cocci profile to Idexx- will call with results.
Recommend going ahead and doing a dewormer for pet even if fecal comes back negative.
TGH with panacur as directed. See Rx. _
Follow up: _pending labwork _
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Interpretive ranges:
<1.0 Low
1.0-4.0 Normal
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
>4.0 High
2.1-5.4 Therapeutic
Dogs with no clinical signs of hypothyroidism and results
within the
normal reference range are likely euthyroid. Dogs with low
T4
concentrations may be hypothyroid or euthyroid sick .
Occasionally,
hypothyroid dogs can have T4 concentrations that are low
normal. Dogs
with clinical signs of hypothyroidism and low or low normal
T4
concentrations may be evaluated further by submission of
free T4 and
canine TSH. A high T4 concentration in a clinically normal
dog is
likely variation of normal; however elevations may occur
secondary to
thyroid autoantibodies or rarely thyroid neoplasia. For dogs
on
thyroid supplement, acceptable 4-6 hour post pill total T4
concentrations generally fall within the higher end or
slightly above
the reference range.
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs