C09975061 / invoice 10000

Reason: RecheckIntern: SNHistory: Moushka presents today for repeat CRP & reassessment of his IMPA (diagnosis Jan 2024). Mouska was initially on leflunomide, however discontinued in Jan 2024 due to gastrointestinal effects. Over subsequent rechecks, Moushka has been doing well, with appropriate prednisolone tapering (last reduction in November 2025). At his last recheck (3/11/25), Moushka was well but had developed erythema of the ventral abdomen and inner pinna, with no pruritus. Today, #####################Current medications:Prednisolone 1mg PO alternating (2 days on 1 day off)Examination Findings:T:  ##                      MM: pink, moistP:  ## bpm               CRT: 1-2sR:  trembling Demeanour: QAR, anxious Hydration: Euhydrated Weight: #### 4.8kg (+400g)Body Condition Score: 5/9Muscle Condition Score: 3/3Cardiovascular: WNLRespiratory: WNLAbdomen: WNLPeripheral LNs: WNLOcular: WNLEars: - mild erythema AU- no exudate present- cytology not obtainedIntegument: - mild erythema ventral abdomen - no dermal changes (collarettes, pyoderma etc)Oral exam: WNLMusculoskeletal: WNL - no palpable joint effusion or discomfortGait: WNLNeurological: mentation appropriate, full exam not performedRectal: NPLaboratory: CRP #### mg/L (0.0-10.0)CBC/MBA (QML): pendingProcedure: NilAssessment: Problem List: Problem list- IMPA - presumed primary idiopathic- PUPD - improved - Biochemical hepatopathy - Hypercholesterolaemia - Hypertriglycerideaemia - Periuria ddx behavioural - Pyrexia - likely stress related, consistent finding- Ulcerated pinneal lesions - improved #############Treatment: ############Plan:####    Vital Signs    

Reason: RecheckIntern: LHHistory: Moushka presents today for repeat CRP & reassessment of his IMPA (diagnosis Jan 2024). Mouska was initially on leflunomide, however discontinued in Jan 2024 due to gastrointestinal effects. Over subsequent rechecks, Moushka has been doing well, with appropriate prednisolone tapering (last reduction to 1mg in August 2025). Today, owner reports that Moushka has been going well, with no major concerns. Moushka has developed some erythema of ventral abdomen & inner pinna, however is not pruritic. Moushka has maintained a good/polyphagic appetite, though other PU/PD signs improved. Moushka has had no vomiting, diarrhoea or episodes of lameness or limb licking. Current medications:Prednisolone 1mg PO SIDExamination Findings:T:  39.4                      MM: pink, moistP:  172 bpm               CRT: 1-2sR:  trembling Demeanour: QAR, anxious Hydration: Euhydrated Weight: 4.8kg (+400g)Body Condition Score: 5/9Muscle Condition Score: 3/3Cardiovascular: WNLRespiratory: WNLAbdomen: WNLPeripheral LNs: WNLOcular: WNLEars: - mild erythema AU- no exudate present- cytology not obtainedIntegument: - mild erythema ventral abdomen - no dermal changes (collarettes, pyoderma etc)Oral exam: WNLMusculoskeletal: WNL - no palpable joint effusion or discomfortGait: WNLNeurological: mentation appropriate, full exam not performedRectal: NPLaboratory: CRP <1.0 mg/L (0.0-10.0)Procedure: NilAssessment: Problem List: Problem list- IMPA - presumed primary idiopathic- PUPD - improved - Biochemical hepatopathy - Hypercholesterolaemia - Hypertriglycerideaemia - Periuria ddx behavioural - Pyrexia - likely stress related, consistent finding- Ulcerated pinneal lesions - improved Moushka has maintained clinical remission for his IMPA. His CRP has remained within normal range, which makes him suitable for further prednisolone tapering. The cause of Moushka's erythema has not been identified today, however may be related to pre-existing dermatological disease, which has previously been managed with prednisolone. Topical therapy may be useful in erythema reduction (topical chlorhexidine bathing vs medicated shampoos). If Moushka shows no improvement, or becomes pruritic, cytology +/- referral to a dermatologist may be recommended. Treatment: Reduce: - Prednisolone 1mg PO alternating (2 days on 1 day off)Plan:Recheck in 2 months. CBC/MBA at next recheck.Discussed dental, this can be done after next recheck when assess CBC/MBA.Discussed desexing - there are no behavioural issues at this stage so is not a rush. Concerns such as prostatitis and perineal hernia can occur but often later on in life.    Vital Signs    Weight: 4.8;       

Reason: RecheckIntern: JDBHistory: Moushka presents today for a recheck of his presumed primary idiopathic IMPA. He was diagnosed on 15/01/24, initially with the surgery department and was later transferred to IM on 24/01/24. Please refer to previous records for a comprehensive history. On 23/1/24 leflunomide was discontinued due to vomiting and anorexia and has not been recommenced,At his last recheck on 19/05/25 Moushka had been doing well, with a marked improvement in his polyphagia and no appreciable polydipsia. Haematology was unremarkable and biochemistry reported mild improvement in biochemical hepatopathy, that is suspected to be secondary to his prednisolone use. His prednisolone was reduced to 1.5mg PO SID. Today O reprots that Moushka has been well, with no lameness or relapsing clinical signs. He has been EDUD normally, with no v+/d+. No concerns today. Current diet: taste of the wild dry kibble, occasional cooked meat. Current medications:Prednisolone 1.5mg PO SIDExamination Findings:T:  39.6                      MM: pink, moistP:  188 bpm               CRT: <2R:  44bpm/trembling Demeanour: QAR, anxious Hydration: Euhydrated Weight: 4.4kg (static) Body Condition Score: 5/9Muscle Condition Score: 3/3Cardiovascular: WNLRespiratory: WNLAbdomen: WNLPeripheral LNs: WNLOcular: WNLEars: WNLIntegument: WNLOral exam: WNLMusculoskeletal: WNL - no appreciable pain or effusion, appropriate ROM. Gait: WNLNeurological: mentation appropriate, full exam not performedRectal: Not performedLaboratory: CRP 2.0 mg/L (0.0-10.0) (cf <1.0mg/L)Procedure: Nil today Assessment: Problem List: Problem list- IMPA - presumed primary idiopathic- PUPD - improved - Biochemical hepatopathy - Hypercholesterolaemia - Hypertriglycerideaemia - Periuria ddx behavioural - Pyrexia - likely stress related, consistent finding- Ulcerated pinneal lesions - improved Moushka has remained clinically stable, and in remission of his IMPA. His CRP has remained WNL with the prior reduction in his prednisolone dose. Given his stability, a further dose reduction is appropriate today. Treatment: Nil today Plan:Reduce prednisolone to 1mg PO SIDRecheck in 2 months.    Vital Signs    Weight: 4.4;       MMColour: Pink;       Temperature: 39.6;       HeartRate: 188;       BodyScore: 5/9;       RespirationRate: 44;       CRT: 1-2s;