DOB. Apr 07, REMINDERS. Aug 14, Apr 11, Aug 14, 2019 PATIENT ALERTS (MANUAL)

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1 Medical Chart PATIENT SPECIES AGE Mango Canine 0 years OWNER Carmen Chow SEX Spayed Female BREED Lhasa Apso DOB Apr 07, 2007 ADDR 28 Orsi Circle COLOR MARK White/Brown San Francisco, CA 9424 ID TATTOO RADIO PHONE RABIES OTHER NOTES REASON FOR VISIT IN OUT PROBLEMS REMINDERS Aug 4, 207 sbordory sbordetella Oral Vaccine (y rem for sbordor Apr, 208 Office Call Office Call Aug 4, 209 srvcan3y Canine Rabies Vaccine WEIGHT HISTORY 0.00 kg PATIENT ALERTS (MANUAL) MEDICAL HISTORY ITEM DESCRIPTION QTY ALL HISTORY Benavidez, Kelly ed records client comm: Continue episodes of tremb: Note client comm: Continue episodes of trembling, abnormal posturing. Discussed brain dz, spinal cord dz. Discussed trial adding in steroids (instead of NSAIDs) vs consult with neurologist (eg SFVS). O to consider options, recommend continue gabapentin, tramadol, novox while waiting. Apr 4, 207 Rico, Rebecca xrays GabapenCAPS Gabapentin CAPSULES 00 mg 60 cap Rx Num: Refills: 0.00 After ramping up liquid version to ml every 8-2 hours: Give capsule every 8-2 hours for pain. Gabapen00mg/ml Gabapentin 00 mg/ml 20 liquid Rx Num: Refills: 0.00 Give 0.3ml every 8-2 hours for 3 days then increase to 0.6ml every 8-2 hours for 3 days then increase to 0.8ml every 8-2 hours for 3 days, then switch to capsules. Labs/client communication CBC/Superch: Subjective Reason for Visit: Lab results and client communication Labs/client communication CBC/Superchem/T4/UA/Accuplex A: no expl for painful episodes- suspect back pain. R/O other pain or brain dz P: Rec add gabapentin - will start with suspension then transfer her to capsules once she's at ml BID If too much sedation rec stop methocarbamol for now Page of 5

2 SWO: A and P Plan Invoiced Items: Gabapentin 00 mg/ml -- Qty: 20 --Give 0.3ml every 8-2 hours for 3 days then increase to 0.6ml every 8-2 hours for 3 days then increase to 0.8ml every 8-2 hours for 3 days, then switch to capsules. Gabapentin CAPSULES 00 mg -- Qty: 60 --After ramping up liquid version to ml every 8-2 hours: Give capsule every 8-2 hours for pain. Curtis Press, DVM Tramadol50 Tramadol 50 mg 50 tab - Tramadol is used for the treatment of pain or cough. When used in combination with NSAIDs, it may be particularly useful for chronic pain conditions in dogs. This medication may cause CNS effects (excessive sedation, agitation, anxiety, tremor, dizziness), or GI disturbance (inappetence, vomiting, constipation to diarrhea). If these symptoms occur, contact your veterinarian. - Do you prefer to order medications or pet food online? Go to and click on the "Online Pharmacy" tab for more details. Rx Num: Refills: 0.00 Give tablet every 8-2 hours for pain. May cause drowsiness. 620-AW Superchem,CBC,T4,& UA DDG Lab Result ID: Status: For Review Laboratory: Profile: Antech - Zoasis West Senior Wellness Profile Test Results Range Superchem Reqested By: Reqested On: 04/4/207 03:2 AM Accession Result ID: Accession Status: F Clinic Accession ID: 0552 Chart ID: Lab Accession ID: SFBC Order Received: 04//207 Latest Results Received: 04/2/207 07:8 AM Pet Name: MANGO Pet Age: 0Y Pet Sex: SF Pet Species: Canine Pet Breed: Pet Owner: CHOW CARMEN Pet Doctor: DAVID GORDON, DVM Total Protein Albumin Globulin A/G Ratio AST (SGOT) ALT (SGPT) Alkaline Phosphatase GGT Total Bilirubin BUN Creatinine BUN/Creatinine Ratio Phosphorus GLUCOSE Calcium Magnesium Sodium Potassium Na/K Ratio Chloride Cholesterol 6.8 g/dl g/dl g/dl IU/L L IU/L IU/L IU/L mg/dl mg/dl mg/dl mg/dl mg/dl mg/dl meq/l meq/l meq/l meq/l mg/dl Page 2 of 5

3 Triglyceride Amylase PrecisionPSL 64 mg/dl IU/L U/L Pancreatitis is unlikely, but a normal PrecisionPSL result does not completely exclude pancreatitis as a cause for gastrointestinal signs. CPK Comment Hemolysis +, Lipemia + No significant interference. Complete Blood Count WBC RBC HGB HCT MCV MCH MCHC Platelet Count Platelet Est Neutrophils Bands Lymphocytes Monocytes Eosinophils Basophils Absolute Neutrophils Absolute Lymphocytes Absolute Monocytes Absolute Eosinophils Absolute Basophils Total T4 T4 URINALYSIS COLLECTION METHOD Not Stated COLOR Appearance Specific Gravity PH PROTEIN 95 IU/L ³/<font face="sy ⁶/<font face="sy g/dl % fl pg g/dl ³/<font face="sy Adequate 66 % % % % H % % /<font face="symbol"> < /<font face="symbol"> < /<font face="symbol"> < H /<font face="symbol"> </ /<font face="symbol"> </fon <font face="symbol"> </fo Dark Yellow Clear.054 H Trace H - Microalbuminuria testing is recommended (if sediment is inactive) to help determine the clinical significance of proteinuria. Glucose-Strip KETONES BILIRUBIN Occult Blood WBC/HPF RBC/HPF Casts/LPF Crystals/HPF BACTERIA Epithelial Cells Fat Droplets Accuplex 4 Heartworm (Antigen) Neg To + - None HPF 0-3 None HPF 0-3 None Seen LPF Hyaline 0-3 None Seen HPF None Seen HPF None Seen - None Seen HPF 2-3 HPF There were no measurable amounts of adult female heartworm antigen in this sample. Adult Dirofilaria immitis antigens will not be detected for 5 to 7 months following exposure to early larval stages. Borrelia burgdorferi Exp... Exposure And Vaccine There were NO measurable antibodies detected against tick-borne Borrelia burgdorferi antigens or vaccine antigens in this sample. Seroconversion may not occur for 2-3 weeks after Lyme vaccination or up to 9 weeks after natural exposure in dogs. Vaccine antibodies can also wane over time following vaccination; however, these patients may still be immune to natural infection. Page 3 of 5

4 Ehrlichia Canis There were no measured antibodies to Ehrlichia canis in this sample. Seroconversion may not occur for to 4 weeks following pathogen exposure. If acute infection is clinically suspected (e.g. thrombocytopenia, anemia, hyperglobulinemia, fever, lymphadenopathy and/or tick exposure) a CBC, chemistry profile and UA along with PCR testing may help identify acute and/or active infection. Anaplasma phagocytop There were no measured antibodies to Anaplasma phagocytophilum in this sample. Seroconversion may not occur for 2 to 4 weeks following pathogen exposure. If acute infection is clinically suspected ( i.e. thrombocytopenia, fever, lymphadenopathy and tick exposure) a CBC, chemistry profile and UA along with PCR testing may be beneficial to identify acute and/or active infection. AC00 Accuplex 4 (HW AG, Lyme AB, Anaplasma, E. canis) DDG Lab Result ID: Status: For Review Laboratory: Profile: Antech - Zoasis West Accuplex 4 Test Results Range Office Call Office Call - MPH is available to see emergencies at 7AM, Mon-Fri, on a walk-in basis. Since this is not a scheduled appointment, there may be a wait depending on the urgency of the problem and other patients that might be sick as well, & the emergency exam fee may be $30.00 instead of the regular office call exam fee. Ultimately, until 7AM, you will need to judge the urgency of the problem and take your pet to an emergency facility if needed. Dr Gordon second opinion Subjective Reason for Visit: Exam Dr Gordon second opinion Simnce Jan: Simnce Jan 207, epsidoes of whole body trembling adn disomcort. Dog also increasingly strestches out and lays sternally. Epsidoes are more likely to occur at night. Recent dental with exractions abourt 3 weeks ago Tdx by vet in pacifica -aanxiety attacks and arthritis. Tx: novox 25mg SID-BId, methocarbamol 500mg BID, adequon inj twice weekly. No improvement Occ cough recently, worse since dental Labwork a few weeks after epsodes started - (chemistry./cbc): wnl mature cataract O notes increasingly evident backbone and occipital protuberance in last few months. No overt lameness. Objective Vitals: 2:36pm 4//7 Wt: 0 kg. T: 0.9 F. By: DDG General Appearance: Bright, alert, responsive. Hydrated. Body Condition: 5/9 Eyes: cataract OS. Dry appearing eyes OU Ears: No exudate or redness. Integument: Clean full hair coat. Oral Cavity: Mucous membranes pink and moist. Lymphatics: No peripheral lymphadenopathy Cardiovascular: Regular rhythm; no murmur detected. Musculoskeletal: Ambulatory x 4. Gastrointestinal: No obvious masses or organomegaly. Urogenital: External genitalia appear normal. Respiratory: Eupneic. No crackles or wheezes. Neurologic: increased Right patellar reflex Assessment suspect episodes of pain R/O brain dz Plan Invoiced Items: Office Call -- Qty: --- MPH is available to see emergencies at 7AM, Mon-Fri, on a walk-in basis. Since this is not a scheduled appointment, there may be a wait depending on the urgency of the problem and other patients that might be sick as well, & the emergency exam fee may be $30.00 instead of the regular office call exam fee. Ultimately, until 7AM, you will need to judge the urgency of Page 4 of 5

5 the problem and take your pet to an emergency facility if needed. Accuplex 4 (HW AG, Lyme AB, Anaplasma, E. canis) -- Qty: Superchem,CBC,T4,& UA -- Qty: Office Call -- Qty: --- MPH is available to see emergencies at 7AM, Mon-Fri, on a walk-in basis. Since this is not a scheduled appointment, there may be a wait depending on the urgency of the problem and other patients that might be sick as well, & the emergency exam fee may be $30.00 instead of the regular office call exam fee. Ultimately, until 7AM, you will need to judge the urgency of the problem and take your pet to an emergency facility if needed. Tramadol 50 mg -- Qty: Tramadol is used for the treatment of pain or cough. When used in combination with NSAIDs, it may be particularly useful for chronic pain conditions in dogs. This medication may cause CNS effects (excessive sedation, agitation, anxiety, tremor, dizziness), or GI disturbance (inappetence, vomiting, constipation to diarrhea). If these symptoms occur, contact your veterinarian. - Do you prefer to order medications or pet food online? Go to and click on the "Online Pharmacy" tab for more details. --Give tablet every 8-2 hours for pain. May cause drowsiness. DUE DESCRIPTION STATUS ENTERED BY RESOURC QTY COMPLETED Notes: Results: Page 5 of 5