C09970993 / invoice 10000

Reason: Haematuria - In CarAppointment Notes: Overdue reminders(Note - O is a paediatrician)HISTORY:Otis is a 8y 4mo MN (confirmed desexed) Beagle who presented today for acute onset haematuria O said she thought she saw drops of blood yesterday but only today noted it was in his urine - has free catch collected 20 minutes before consult First time with this issue - O confirmed still eating, drinking, defecating, is bright and urinating with out discomfort Current meds: Meloxicam daily for suspected OA (has been on this approx. 5 months Did have access to garden fertiliser however not seen/evidence of him eating it Prophylaxis: UTD Pre-existing conditions: OA, VERY anxious *O warned can be aggressive to vets usually has housecall vet come to home with gabapentin/trazadone on board Access to toxins eg. Rodenticide: No access EXAMINATION:Due to behaviour and severe anxiety did not perform exam - O said she has gabapentin/trazadone at home but came straight down w/o it on board Patient in care very anxious, trembling in car opted to not perform physical exam O understanding and would prefer he had sedatives on board first given past experiences with vets DIAGNOSTICS:Urine was collected for testing in house. Collection method: Free catch 20 minutes before consult The results of this test were:USG: 1.020Colour: red/bloodyTurbidity: High pH: 6Protein: 1+Blood/Hb: 4+Ketones: Neg Bilirubin: Neg Glucose: 1+ Wet preparation: no evidence crystals Stained preparation: VERY cellular sample - squamous cells present morphology appears normal - transitional cells abnormal appearance (multiple cells with 2 nucleolus, mitotic figures present or abnormal cytoplasm) occasional band neutrophil - no bacteria noted on sample Interpretation: Transitional cell carcinoma very likely ASSESSMENT:Dx transitional cell carcinoma likely other DDx uroliths/stones Discussed finding with O - advised likely to be TCC however ideally needs full workup to confirm if present and location/size. Estimated $1700-2000 for sedation, bladder US/cysto, send away UA with cytology and radiographs to rule out urinary stones, or monitor for now and have work up with GP. O opted to discuss results with her regular veterinarian, made O aware can have mobile ultrasonographer come to clinic or do out patient US with a specialist hospital and they can send results to her veterinarian. Advised O if he becomes flat, seems uncomfortable to come back overnight. Discussed benefit of meloxicam with TCC and advised to continue regular dosing for now. Offered to send away urine sample today for send away cytology but warned as not cysto sample may not be confirmed and another sample will be requested, O opted to not send away sample today aware we do not hold onto samples. PLAN:- Continue meloxicam as directed - If becomes flat, appears painful to urinate or seems not himself to return overnight - O aware reg vets will have clinical notes from today advised to call tomorrow early as has house call appointment in PM but warned vets may change plan or appointment based on history today    Vital Signs    Weight: 35;       

------------------------------------------------------------------------CLIENT DISCHARGE NOTESPRESENTING CONCERNS:Grape Ingestion PROBLEM LIST FROM PHYSICAL EXAMINATION AND HISTORY:Grape ingestion x 2ASSESSMENT:Grape Ingestion PLAN/DISCUSSION:Induction of emesis - removed 2 grapes TREATMENTS ADMINISTERED (medications, amount and time administered):Apomorphine tablet 1.5 tab PO @7:30Medications for Administration at Home:NIl SPECIFIC HOME CARE INSTRUCTIONS:Post Emesis Discharge InstructionsYour pet has been administered a medication to induce vomiting (emesis) to try and remove a suspected object or toxin from the stomach.They may have also been administered an anti-nausea medication to reduce the risk of further vomiting.Monitoring at home:* It is possible that your pet may have a further vomit, if this does occur it is likely to occur within 15-30 minutes of discharge.* The mediations administered may also cause some sedation for up to an hour and should be closely monitored for the first few hours once at home.* It is not recommended to feed your pet within the first 2 hours after having induced vomiting.* If there is continued vomiting, your pet becomes dull or lethargic or there are any other concerns, please contact the Animal Emergency Service or your primary care veterinarian immediately.Recheck:The Animal Emergency Service recommends a recheck with your primary care veterinarian within 48 hours to monitor your pets condition.Thank you for trusting the Animal Emergency Service with the care of your pet.--- 26/06/2020 07:07:39 AM BJJ:Examinations - Resolved - FOLLOWUP ACTION TAKEN:BJJ26/06/2020Have been unable to contact client by phone.  Followup email has been sent.    Vital Signs    

Reason: Grape IngestionHISTORY:Otis ingested 2 grapes 30 minutes prior to arrival + had dinner Otherwise well. Hx of severe hospital associated anxiety and aggression.** On presentation discussed with owners given age, no known health issues, no history of being unwell and on visual exam being bright, alert, responsive, pink gums - they consented to not performing a full physical exam considering how Otis reacts at vet clinics **Discussed that generally apomorphine is safe and indicated for his presenting condition and normal  visual exam with owners again understanding that a full physical exam will not be performed- owners applied 1 tablet (accidentally crushed and failed to administer the first tablet) to the gums - successful emesis with veterinary monitoring - no anti emetic provided - as patient is very needle adverse - vomiting was self limiting - BAR, not vomiting prior to discharge ** owners very happy with visit and care, commenting this is his least stressful veterinary experience. ASSESSMENT:Grape Ingestion PLAN/DISCUSSION:Induction of emesis - removed 2 grapes TREATMENTS ADMINISTERED (medications, amount and time administered):Apomorphine tablet 1.5 tab PO @7:30Medications for Administration at Home:NIl SPECIFIC HOME CARE INSTRUCTIONS:Post Emesis Discharge InstructionsYour pet has been administered a medication to induce vomiting (emesis) to try and remove a suspected object or toxin from the stomach.They may have also been administered an anti-nausea medication to reduce the risk of further vomiting.Monitoring at home:* It is possible that your pet may have a further vomit, if this does occur it is likely to occur within 15-30 minutes of discharge.* The mediations administered may also cause some sedation for up to an hour and should be closely monitored for the first few hours once at home.* It is not recommended to feed your pet within the first 2 hours after having induced vomiting.* If there is continued vomiting, your pet becomes dull or lethargic or there are any other concerns, please contact the Animal Emergency Service or your primary care veterinarian immediately.Recheck:The Animal Emergency Service recommends a recheck with your primary care veterinarian within 48 hours to monitor your pets condition.Thank you for trusting the Animal Emergency Service with the care of your pet.    Vital Signs