C09977073 / invoice 10000

Reason: Libre Senosro InHISTORY:Presented for placement of a continuous glucose monitor (Libre sensor). The primary concern on presentation is a suspected urinary tract infection (UTI).The owner reports Poppy was unwell last night with significant pollakiuria and stranguria. She was taken outside 10-20 times, passing only a few drops of urine each time. The behaviour repeated every 20-30 minutes.There has been some vomiting over the past two days.The last diagnosed UTI was approximately 1.5 years ago, at the time of her diabetes diagnosis.The owner also reports the right eye has been more weepy than the left.Current meds:vettoryl 10mg capsules, twice daily.Tacrolimus and accular eye drops, both eyes, twice daily.Insulin, once daily.Vaccination: UTDParasite Prevention: UTDPre-existing conditions: Diabetes Mellitus, Cushingss; Diabetic cataracts; Keratoconjunctivitis Sicca (KCS).Access to toxins eg. Rodenticide: noneEXAMINATION:Weight: 4.3kgBody Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: Not mentionedRespiratory: Not mentionedNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:Oral: normal, no mouth pain, dental score (1-4): not gradedAbdominal: bladder wall thickened on ultrasound palpation.Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: Schirmer tear test previously performed showed 0 mm/min in the right eye and 12 mm/min in the left eye. Dryness around the right eye noted.Demeanour/Behaviour: not discussedPROBLEM LIST:Suspected UTI (pollakiuria, stranguria)VomitingKeratoconjunctivitis SiccaUnregulated Diabetes Mellitus secondary to suspected UTIDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Urinary Tract Infection (bacterial vs sterile cystitis)DIAGNOSTICS:ABDOMINAL Urinary Ultrasound ResultsUrinary Bladder: Bladder wall is thickened.Urine: Anechoic urineKidneys: Bilaterally normal echotexture and echogenicity, no peri-renal inflammation or fluidCystocentesis Performed (Y/N): YesUrinalysis (in-house dipstick):Leukocytes: 3+Glucose: 3+Protein: 3+Specific Gravity: ConcentratedpH: NormalBlood: NegativeUPC: 3+ (likely affected by glucosuria and proteinuria)Urine was noted to be cloudy.Plan to send urine sample obtained via cystocentesis to an external laboratory for full urinalysis. A culture will be added if bacteria are seen on sediment examination.ASSESSMENT:Poppy presented for glucose sensor placement but has clinical signs consistent with a UTI, including pollakiuria and stranguria. In-house urinalysis supports inflammation within the bladder (leukocyturia, proteinuria) and shows significant glucosuria. The bladder wall was noted to be thickened on ultrasound. The glucosuria is likely contributing to the development of a UTI. The plan for glucose sensor placement has been postponed as the readings would be unreliable during an active infection.TREATMENT:Poppy discharged home.Loxicom: 0.25ml orally once daily. The owner has an in-date bottle at home. A 1ml syringe was provided.Maxalon: for vomiting, half a tablet orally twice a day.Hylo-Forte eye drops: recommended for KCS, over-the-counter lubricant, for use in the right eye.PLAN:Await external laboratory urinalysis results (expected tomorrow).A culture and sensitivity will be added if bacteria are identified.Antibiotics will be initiated if a bacterial infection is confirmed.Postpone placement of the Libre glucose sensor until the UTI is resolved.Re-evaluation will be scheduled to assess glucose control once the infection has cleared.Home into owner's care.CLIENT COMMUNICATION:Discussed the high suspicion of a UTI based on clinical signs and in-house urine testing. Explained that the glucosuria associated with her diabetes creates a favourable environment for bacterial growth. Discussed the plan to send urine for external laboratory analysis to confirm the diagnosis and guide treatment, particularly regarding the use of antibiotics. Advised that the planned glucose sensor placement would be postponed as the results would be inaccurate due to the concurrent illness.Instructions were provided for administering Loxicom for bladder inflammation and metronidazole for vomiting. The owner was advised to use the existing in-date Loxicom at home. Advised on the use of over-the-counter Hylo-Forte for her dry eye.The owner was informed that I will call with the urinalysis results tomorrow and discuss the next steps. I will organise the script for Atopica to be ordered from Bova and sent to the owner.Reason: Nurse: -vaccination -heartworm -worming -flea/ticks Exam: Lab: Assessment: Treatment: Plan:    Vital Signs    Weight: 4.3;