C09974094 / invoice 10000

Reason: UTI Symptoms AgainHX - Was a little skittish last week Urinating more than normal in the litterStarted gaba again on Friday - has been giving BID since then - Have been giving the full 100 mg - did trial 50mg but was not doing much.  From last night has been urinating in the corner. LIcking vulva a lot. Has been on clomav 5mg for 6-7 weeks. Was not on any other meds for the last fortnight and she seemed well. Last had an episode approx 3 weeks ago  Had urinalysis and u;trasound in December. Did not have C and S Planning to renovate and have a baby due in July but these should not be triggers at the moment. Saw a pet behaviour/trainer - not a vet. Were very  helpful and she did improve for about a fortnight untill the current issue which has come out of the blue.  Only possible trigger is that female owner went to hospital through emergency and was unwell. Trainer went through a lot of environmental enerichment. INdoor and balcony access. No other cats at home Owners work from home except fpr one day per week. Hve chachanged with the hills c/d stress and a regula wqet food. EXAMMentation: BARFeisty so quick ecam - palpated abdo - bladder empty. Genital area NAD ASSESSMENTFeline idiopathic cystitis - Stress-related urinary episodes continuing despite 6-7 weeks of clomipramine therapy. Current episode likely triggered by owner's recent illness and household stress. Patient has had comprehensive diagnostic workup 3 months ago ruling out underlying pathology.PLANNew Meds/Tx:- Continue current gabapentin (100mg capsule BID) and add meloxicam for current flare-up for approximately one week- Option to transition from clomipramine to fluoxetine if current episodes continue - would require tapering clomipramine (quarter tablet every second day for 2 weeks), then 2 week medication-free period before starting fluoxetine- Fluoxetine would be compounded medication costing approximately $200 for 3 months supply, requiring one week lead time for ordering- Great that they have sarted c/d - Urinary diet is long-term management option that can be fed indefinitely and may help us avoid medications. - Recommended waiting to see if diet is effective before switching to fluoxetine (as switching is a lengthy process) but owners dont want to be caught out and doing a switch at the time their baby is expcted- Will discuss together at home and let us now if we need to order fluoxetine close to the time they finish the clomav.  Additional Discussion:- Provided two website resources: veterinary partner article on idiop[athic cystitis and Indoor Pet Initiative for environmental enrichment- Recommended "tell your cat you're pregnant" book. - Dscussed option for veterinary behaviourist consultation available ($750 for 2-hour visit plus 8 weeks email support) though current behaviourist appears effective- Urine culture remains only diagnostic test not yet performed but condition appears stress-related. MAde owner aware of this - we can always submit urine for C and S if there is no improvement at anytime. . - Happy for owner to self medicate with gaba and loxicom at home when she has a flareup but asked that they record all the dates. Can use each for a week at a time. - Safe for long-term intermittent meloxicam use based on good kidney function - conentrated USG. SHould not be given if she is  "unwell" off food or vomiting.  Client Comms:- Discuss medication transition options with partner before deciding on clomipramine vs fluoxetine change- Contact clinic at least one week before requiring fluoxetine if choosing to transition    Vital Signs