C09977816 / invoice 10000

Initial ConsultationRecord is In/CompleteVet/Nurse (Initials): HT/JB/AKPresenting problem: Anorexia and hematocheziaHistory:Age obtained: PuppyPlace obtained from: RescueVaccination status: No recorded vaccinatio historyParasite prophylaxis: No regular use, last treatment a few years agoRegular diet: Combination of Lyka wet food and Royal Canin gastrointestinal high fibre dry food. Refused both for around one week.Environment: Both indoors and outdoorsExercise tolerance: Fairly sedentary. Short sniff walks but not over the past two weeks.Travel history: Yes, most recent trip to Warburton over New YearsOther pets: NoPrevious/concurrent medical conditions:1. MMVD C with concurrent pulmonary hypertension:Initially diagnosed with stage B2 MMVD in early 2024 and was managed with pimobendan. In late 2024, she represented with cough, where she was coughing up fluid, frusemide commenced that resulted in clinical improvement. In 2025, Wilma was diagnosed with pulmonary hypertension after syncopal episodes, and sildenafil was started. 2. Azotemia documented on 5/1/2026: creat 217, urea 33.3, SDMA 16Has had progressive hyporexia and progressed to anorexia. Treated with maropitant and mirtazapine which has not resulted in clinical improvement. Has had AUS with Dr. Ramoo on 26/2/2026 which showed mild stomach and GI thickening of 4mm (no comment on wall layering), splenic nodules, hepatic nodules (no FNA performed), and bilateral adrenomegaly. Intermittent periods of hematochezia and straining. No vomiting/diarrhoea. Has been trying to tempt with multiple different foods but eating <50% normal diet despite mirtazapine and maropitant use. Results:Clin path results:23/02/2026Creat 260 (44-159)Urea 45.7 (2.5-9.6)Phosphorus 4.38 (0.81-2.2)ALT 212 (10-125)TT4 16 (13-51)5/1/2026SDMA 16 (0-14)Creat 217 (44-159)Urea 33.3 (2.5-9.6)Potassium 3.4 (3.5-5.8)ALT 197 (10-125)30/04/2025Creat 175 (44-159)Urea 21.6 (2.5-9.6)Potassium 3.4 (3.5-5.8)ALT 153 (10-125)TT4 8 (13-51)Echo:05/03/2024MMVD Stage B2 with mild LA enlargement23/09/2025MMVD B2 with marked atrial distensionSignificant pulmonary hypertensionU/S:05/03/2024Splenic nodule - 4.2mm hypoechoic nodule in the bodyHepatic nodules - described as very smallBilateral adrenomegaly - 6.6mmx11.8mm26/02/26GI thickeningSome renal changes seenGall bladder sludgeLiver changesCurrent medications: Pimobendan 1.56mg PO BID- since March 2024Frusemide 10mg PO TID - since October 2024Sildenafil 6.25mg PO BID - since September 2025Mirtazapine 7.5mg PO SID - since February 2025Cerenia 12mg PO SID - since February 2025Monthly pentosan injectionsExamination Findings: Marked periodontal disease and dental calculus. Bilateral nuclear sclerosisGrade IV/VI left systolic apical murmur, grade IV/VI right systolic murmur, good pulse quality synchronous pulses, warm extremeties. Abdominal palpation is normal and rectal exam is normal. Remainder of clinical examination is unremarkableLaboratory: GLU 7.25 mmol/L 3.89 - 7.95 	CREA 402 µmol/L 44 - 159 H 	UREA > 46.4 mmol/L 2.5 - 9.6 H PHOS > 5.20 mmol/L 0.81 - 2.20 H CA 2.08 mmol/L 1.98 - 3.00 	TP 72 g/L 52 - 82 		ALB 34 g/L 22 - 39 		GLOB 38 g/L 25 - 45 		ALB/GLOB 0.9 ALT 166 U/L 10 - 125 H ALKP 83 U/L 23 - 212 		GGT 2 U/L 0 - 11 				TBIL 5 µmol/L 0 - 15 			CHOL 6.18 mmol/L 2.84 - 8.26 		AMYL 883 U/L 500 - 1500 	LIPA 454 U/L 200 - 1800Assessment:Plan:Treatment:Telephone Conversation:    Vital Signs    Weight: 5.14kg;       MMColour: pink;       Temperature: 38;       HeartRate: 120;       BodyScore: 4/9;       DentalGrade: 3/4;       RespirationRate: 44;       CRT: 1sec;