C09975508 / invoice 10000

Reason: Health CheckAppointment Notes: Overdue reminders  ------- Sms reply: YConsent for use of Heidi was obtained.History:Nala sits by the water bowl frequently and drinks more water than usualOwner initially consulted Dr. Spot last Thursday who suggested the behaviour might be related to working from home situation changesAfter eating dry food, Nala always drinks waterPrevious blood work performed approximately 1 year ago showed slightly elevated glucose and low B12Currently on Cobalazorb for B12 supplementation long termOngoing mild constipation with firmer stools than ideal, previously dark coloured but now normal brownNo recent blockagesIntermittent ear scratching, particularly left earOwner reports rapid breathing even when restingUrination frequency 3-4 times daily with normal volume outputCurrently receiving Zylkene supplement as prescribed by Dr. Spot for suspected behavioural issuesOn sensitive stomach dietExamination:Mentation - BAREars, eyes, nose - NADOral - front teeth examined, NAD, unable to examine back teeth due to temperamentLNs - NADSkin, nails and coat - NADAbdo palpation - small amount of urine in bladderMSK - NADGait - NADChest ausc - grade 3/6 heart murmur detected (new finding)Genitalia - NADHydration - WNLCRT <2sMMs pink and moistBW - 6.0 kg (previously 5.6 kg, significant weight gain)Assessment:ObesityGrade 3/6 heart murmur (new finding)Polydipsia - differential considerations include diabetes mellitus vs other metabolic disease vs behavioural Treatment:Attempted clipping for blood collection - unsuccessful due to patient stressClient Communication:Discussed significant weight gain and obesityExplained new heart murmur finding and need for investigation Discussed polydipsia as potential indicator of underlying disease, particularly diabetes mellitus in overweight catsRecommended baseline blood work including general chemistry panel and cardiac enzymes (proBNP)Discussed urinalysis collection options including home collection vs cystocentesisExplained echocardiogram recommendation pending blood work resultsDiscussed sedation requirements for procedures given patient temperamentProvided information about Healthy Pets Plus senior wellness plan including cost savings for recommended diagnosticsOwner elected to join Healthy Pets Plus annual planPlan:Gabapentin premedication protocol - 2 tablets night before appointment and 2 tablets 2 hours prior to visitBlood work appointment scheduled for Thursday 05/03/2026 at 1:30pm including general chemistry panel and proBNPHome urine collection kit provided with instructionsRecheck heart murmur grading at next visitConsider echocardiogram pending blood work resultsAdditional gabapentin dispensed for future visits - 200mg night before and morning ofWeight management discussion and dietary recommendations to be addressed at follow-up--- 02/03/2026 14:13:38 ASH:Owner signing up to senior HPP plan. Had no data service in clinic to sign up. Gave insurance details. Instructed owner to sign up at home today. WIll process insurance when notes done. Will send HPP link after insurance processed and HPP payment made for plan to be active, so owner only pays remaining amount.    Vital Signs    Weight: 6;       

    Vital Signs    

Reason: Picking Up CobalazorbAppointment Notes: Overdue reminders    Vital Signs