146am: more than 36h dr ym didn’t reply to: Dr, Guai Guai feeder asked:”Cat, GG was given med into the nubulizer for 10 day but still she sneezing, She like block nose , can help to ask dr Y can give her med anot” – so agnes mainly want to know if there is any contradiction w the current meds which I know no, so Guai is starting on doxy today onwards. one Course 11 days worth, see how. From video she sound like block nose. weight: 2.67kg, dose 0.25ml. 

Agnes: “Yes just now i give her she almost finish it i so happy, She got eat dry food too”

Inform Agnes that I’ll be packed w lessons today, so leave it to her to decide and liaise w clinic re Guai le.
402pm: Agnes inform me :”Jess told me that vet say GG like Garflied with kidney failure can go any time, if you were me will you still insert nasal tube ?” – I check w dr ym
Y:”I haven’t got the results yet, but I just warned her that her condition isn’t looking great. She has a pleural effusion on left side chest. Bloody nasal discharge from left nostril also. More quiet today so I think feeling worse. I have put her in oxygen until she is here to discuss options. I think we cannot put feeding tube as breathing already not good.”
• 430pm: Agnes: They want her to hospitalise” – i ask dr ym on What’s the diff of her hospitalising via going home w her? – “Oxygen therapy, IVF. Il probably want to start IV antibiotics. Also, we have to sedate her a bit to drain the chest, so recovery. But high risk procedure. Ah, well you can, if you are ok with it. But like Garfield, prognosis not good. But also, have to drain the chest first and see how she does after that. If breathing is bad, or bad recovery from sedation, may have to stay here or go to overnight intensive care.” – thought Agnes will hospi Guai at least for tonight n see how cos of this. End up only tap the chest and did nothing of the following: no nasal tube, no iv, no hospi. bring home med: spironolactone 1/4 of 25mg (dusty on this for heart), cidopodogrel 1/4 of 75mg, Marbo start again?, Buprenophine 0.2ml that’s the higher dose alr – mean dr ym think she is in pain.
• bp 190
• 837pm: sigh agnes brought Guai back didn’t hospi
• dr ym; “I didn’t use much sedation cos I was scared for her heart so didn’t need to wait here. No IV, they decided not to do IVF and meds, just to keep her comfortable and pain free. I started more oral meds to try to avoid fluid buildup. I suspect her heart is enlarged, but cannot say if due to the high BP or underlying heart issue. In any case I started some meds to help protect against clot formation. For now I said just don’t go more than 80ml SC every other day because she is still dehydrated, but since she still drinks maybe can reduce.”
• asked dr ym what will b the diff if Guai is in my hand “I would not do nasal tube now, since bloody discharge from the nose today. But I would do IV for fluids, antibiotics and in case breathing gets worse again, to give frusemide quickly”

Morning: got poo 8cm formed poo. 

got vomit. 

Agnes says she thinks yesterday’s panting episode start after she Subcut. 

1225pm: given dr ym update n ask if need to change Subcut plan. 

Dr ym; “Pls ask her to stop the fluids for the next few days to see if the panting improves. We may need to take xrays if persistent. Is she eating and drinking on her own?” – eating no, drinking yes. Syringe feeding. 

Night: video body breathing didn’t look that heavy, but mouth got movement. Tmr manage to get a slot at 4pm to see dr ym.

713pm; update from agnes: “GG breathing like very heavy. She 4 day nv poo” 

942pm: “She just poo” – total not even 2.5cm, hard. 

Duno they give probiotics or not. 

Unknown status 

Go see gg cos Duno what ac go ask gg about Pts, go sayang her. Her eyes looks damn scary and cui. I really think she is in pain. No mention about pain killer etc. 

Today main core point:

1. weight remain same
2. Pcv didn’t drop further, kiv 2nd dose of darbepoetin
3. Bp sky high 230-240, despite on 1/8 amlopidine and 0.75ml Semintra 
4. Today up fluid to 140-150ml (monitor breathing), up amlopidine to 1/4, up semintra to 1.3ml daily, review next Tuesday. 

Review w dr yeumee: “She is blind, I assess retinal detachment from hypertension. Lost weight since last week. I told her prognosis isn’t good. But we try a few more meds, see how we go. Btw I didn’t add pain relief yet because I didn’t want to overwhelm with too much meds. Also might benefit from IVFt but was still eating according to her, so I left it for now.” 

Guai continue Marbo and semintra, started on amlopidine. started on darbepoetin when her HCT is 27%, unsure why.