C09976302 / invoice 10000

    Vital Signs    

Reason: Only 2 Urines Over The Weekend And Not Eating/drinAppointment Notes: Keisha vetcxHistory: Presenting for: Birdie, presented for decreased appetite and lethargy over the past week, with complete anorexia since Friday night and vomiting Saturday morning. Although ate small amount this morning. Normally very fussy anyway but has also been drinking nothing (O syringing electrolytes etc) Historical Conditions:- Previous severe pancreatitis requiring 10 days hospitalisation at specialist facility (couple years ago) with recurrent pancreatitis bouts since. - Recurrent UTIs over past few months  - Previous urinalysis 25/2 (one week ago) - normal  Diet:- Currently on Prime 100 kangaroo and chicken diet, previously did well on this- Has been a poor eater historically but appetite significantly worse past 2 weeks- Complete anorexia since Friday night- Ate approximately 1 tablespoon this morning (first food since Friday)Drinking/Urination:- Drinking much less than normal, hardly anything voluntarily- Required syringe feeding of electrolytes Friday night- Did one large urination Saturday night around 12:30am- Tiny urination this morning- Only defecated once since FridayV/D/C/S:- Vomited Saturday morning after wanting to eat grass (indicating nausea/abdominal upset)- One large, loose bowel movement this morning Current Medications and Doses:Maxolin (metoclopramide) BID or otherwise won't eat - has been on this for years Gabapentin PRN for anxiety Pro-kolin BID long term but not recently Cystopro = stopped a few days ago (only had 2 doses) = making her nauseous? Cytopoint PRN Examine:     Demeanour: BAR     Eyes: N     Ears: N    MM: Pink, moist     CRT: <2 sec     Dental:         Gingivitis: 1/3         Calculus:  2/3    Skin/Coat: N     Cardiovascular: N     Abdominal: Gas palpated in mid abdomen, mild pain in caudal abdomen, generalised tension,     Musculoskeletal: N     BCS: 7/9    T: 38.7C     Urogenital: hooded vulva, mild erythema on most distal vulva. Laboratory: CBC: - Eosinophilia: 1.1 (0 - 0.8) - Monocytosis: 0.7 (0.0 - 0.4) - MCHC: 396 (301 - 388) Biochem: - Mild hyperglycaemia: 6.8 (3.3 - 6.1) UA: Free catch - Yellow, Clear - USG: - Blood: 4+- pH: - Pro/ket/glu: -ve - wet & Dry prep: -ve Quick U/S: bladder is empty, no cystitis, no sediment, no stones / masses. No free fluid. CPL: 58 +- 60 (0 - 200) Differential Diagnosis: Gastritis vs dietary indescretion vs pancreatitis vs IBD Marked periodontal disease Treatment: - Maropitant SC 0.8mlPlan:Low fat I/D Cerenia PRN Continue metoclopramide Advised O she needs a dental - likely contributing to Hx of fussy eater / hyporexia Diet Recs:- Trial Hill's i/d low fat diet - can return for full refund if not accepted- Can mix with current Prime 100 initially to encourage transitionAdditional Discussion:- Dental procedure recommended to address significant calculus and improve eating comfort - estimate provided - Full abdominal ultrasound with sedation recommended as next step if no improvement with current treatment plan- Weight reduction advised - target weight 6.5kg, monitor by rib palpation every couple weeksClient Comms:- Will call with pancreatitis test results- Return if condition worsens or no improvement- Dental procedure discussion including anaesthetic risks vs benefits of leaving severe dental disease untreated    Vital Signs    Weight: 7.4;       Temperature: 38.5;       

Reason: URINE SAMPLE NEAR SEDIVUE MACHINE History: presented for evaluation of dysuria/stranguria and apparent vulvar discomfort. Onset of signs approximately 2 days prior, with acute exacerbation of pain noted the evening before presentation. Client reported patient was comfortable the previous afternoon following Metacam administration, but signs recurred acutely that evening.- Getting very low to the ground when attempting to urinate; appears to be in pain during urination- Reluctant to urinate; wanting to sit rather than voidDidn't drink yesterdaySeemed painful as hunched abdo, sitting and scooting.Had metacam yesterday and today at 12. Had been on gabapentin but then stopped - had 100mg last nightAlso had 1/4 panadolPassed urine 10am today,  12midnightAlso on metoclopromide 30min before eats (maxalon) - Previous urinary tract infections treated with antibiotics- pruritic skin disease (allergic)- cytopoint injection worked wellCurrent Medications and Doses:Examine:     Demeanour:    Eyes:    Ears:    Dental:         Gingivitis:    /3         Calculus:     /3    Skin/Coat:    Cardiovascular:     Abdominal:    Musculoskeletal:    BCS: Vulvar mucosa appears erythematous and inflamed Laboratory: USG 1.065. PH6. Prot +, remainder of dipstick negative.- In-house urine sediment microscopy (free-catch sample collected at 1000 this morning):  - No WBCs, RBCs, bacteria, or crystals identified  - Urine markedly concentrated and viscous in appearance  - No evidence of active infection on sediment evaluationDifferential Diagnosis: Pollakiuria/stranguria with vulvar inflammation - Markedly concentrated urine with no evidence of infection on sediment. Vulvar erythema and inflammation (vaginitis) likely contributing to dysuria and reluctance to void. History of recurrent UTIs and prior antibiotic use may have disrupted gastrointestinal and vaginal flora, predisposing to current presentationTreatment: - Cystopro (probiotic/bladder support capsule containing cranberry, glycosaminoglycans, and mucous membrane support agents) - sprinkle capsule contents onto food or administer orally once daily. Dose based on patient weight as per packet instructions (likely 1 capsule once daily). Aimed at rebalancing urogenital flora and supporting bladder wall integrity.- Gabapentin 100 mg - continue morning and evening for several days until signs resolve- Metacam - continue once daily for several days until signs resolveDiet Recs:- Increase water intake to dilute urine and reduce urinary irritation- Consider adding water to food- Reintroduce previously used oral hydration supplement (Hydralite-type product for dogs, added to drinking water) to encourage fluid intakePlan:- If no improvement within 5-7 days, next steps include abdominal ultrasound and cystocentesis urine sample for culture and sensitivity to rule out occult infection or structural abnormality- Cystocentesis sample preferred over free-catch for culture if required- If further workup required: abdominal ultrasound and cystocentesis for urine culture and sensitivity will be recommended at that time    Vital Signs