C09980420 / invoice 10000

History: Toby presents today for abdominal USPrevious hx:- 2015 --> hx GGT elevations- 2021 --> heart murmur 2/6- 2023 --> splenic mass - ARH sx - benign- 2024 --> dermal lumps removed - cutaneous haemangio- 2025 --> Judd echo - gr 1 MMVD - no meds____________________________________________________EDFU normally, no recent V+/D+No current medicationsFasted since last night (6pm 2/3/26)UTD vaccination/worming/flea/tick preventionInsured with Pet Insurance AusPrior anaesthetics – no known issues/concerns No known history of allergiesExamination: BARMM pink, moist CRT 1-2 secHR 120, no murmur/arrhythmia notedRR 32, normal effort, normal bronchovesicular sounds Temp: 38.3oCLaboratory: 23/2/26Haematology: PLT 501Biochemistry: Cr 0.04, ALP 169, ALT 136, CK 516, Amy 273, GGT 25, T4 low (11)Urinalysis - WNLAssessment: Fit for procedureASA Grade II-IIISurgery:Premedication: -- 0.2mg/kg butorphanol (0.3ml) IM @ 0858-- 4mcg/kg medetomidine (0.06ml) IM @ 0858Good level sedationInduction:-- Alfaxan 2mg/kg IV (1ml) @ 1016 slow to effectInduction agent given slow IV to induce anaesthesia. Multi parameter monitoring throughout - record attached.Consent has been given by the client to proceed with this treatment  -  Yes GX Brochure "Caring for your pet after surgery" given - YesUltrasound : - Bilateral adrenal enlargement- pancreas normal- prostate mild enlargement - desexed late?DDx: cushings (PDH) Dr Josh King advised Clopidogrel - 37.5mg PO SID due to L phenicoabdominal vein reduced blood flow - possible risk thromboembolic events (****PLEASE STOP FOR A WEEK IF EVER NEED SX IN FUTURE***) - 40-80% dogs will be hypertensive --- 03/03/2026 11:20:55 RNG:Called O and advised of US preliminary findings + bloods/clinical symptoms possible cushings ( O reports previous test - not indicative - cant see on file?) - advised ACTH stim test - given estimate - O consentTreatment: Bloods drawn at 11:07 - T=00.3ml Synacthen given IVBloods drawn at 12:07 T = 1Sent to IDEXXPlan: Discussed risks/complications pre/post procedure – minor: hypotension/hypothermia, haemorrhage, major: adverse drug reaction and death.Await ACTH stim test resultsGiven VIN handouts - cushings, diagnosis/tx, treatment, testing, clopidogrel    Vital Signs    Weight: 14.5;       HeartRate: 120;       DentalGrade: 1;       RespirationRate: 32;       Temperature: 38.3;       CRT: 1-2;       MMColour: pink;       BodyScore: 5;       

Reason: UA And Blood Idexx Results SK Appointment Notes: Special payment terms exist, Overdue remindersTAHPC + Urinalysis results returned:RETIC ABS   128 x10^9/L     10 - 110        HMCV              78 fL                  59 - 76         HMCHC           313 g/L             326 - 392      LPLT               501 x10^9/L     143 - 448      H CREA            0.04 mmol/L      0.05 - 0.13    LALP              169 IU/L            1 - 150          HALT              136 IU/L            16 - 90          HCK                 516 IU/L           73 - 510        HAMYL            273 IU/L           333 - 1500    LGGT              25 IU/L             0 - 9              HTT4               11 nmol/L         13 - 52           LUrinalysis:  COLOUR    STRAW TRANS       CLEAR USG           1.017 GLU            NEGATIVEBIL              NEGATIVE KET            NEGATIVE HGB            NEGATIVE 								pH               7.0 PRO            NEGATIVE UROBIL      NORMAL (3.2 umol/L) RBC/HPF    < 5 /HPF (<5) WBC/HPF   < 5 /HPF (<5) CASTS         Nil seen BACTERIA   Nil seen FAT              Seen EPI CELLS   Few squamous cells SPERM        Nil seen CRYSTAL    Nil seen DEBRIS       Nil seen Interpretation:Significant changes in liver enzymes inc marked increase in GGT - not totally consistent with Cushings - query hepatobiliary disease (neoplasia? Vs hepatitis, infectious, toxic vs other)Changes in CBC consistent with previous test in 2025, no significant changesLow TT4 - euthyroid sick vs true thyroid diseaseNo evidence of urinary disease or abnormal kidney function on urinalysisPlan:Abdominal ultrasound indicated over LDDST at this time, as Cushings lower on diagnostic suspicion now. Could look at doing AU/S and ACTH stim same day.--- 25/02/2026 15:03:46 NKN:Spoke with O over the phone, keen to go ahead with U/S, have booked in with Josh next week    Vital Signs    

Appointment Notes: Booked via Petbarn App: 19/02/2026 17:48:36 PMBooking Type: Health CheckBooking Notes: General health check, concerns about loss of muscle strength in rear and bladder control. Also need a desexing certificate/confirmation for registration.NUrse:LMM O was away for a couple of months, come back and feel spine and ribs, so thinks lost weight (previously weighed at 17kg)Has spent last 3 moths outside, now inside dog again, now urinating inside, even when laying downExcessive drinking and eating No V or D+Prevention: UTD Nexgard spectraHistory:Was previously warned of cushings being possibility in his future based on bloods (?)Urination - seems to be sudden, without warning, wets himself, bedding etc. Large volume. Frequent. PD, polyphagicCoat is thinning out as wellHas pevious history of haemangiosarcoma, wants belly checkedKnown HM - MMVD, had echo done a while agoExamination: Mentation: BAR, friendlyEyes: nil blepharospasm/erythema/dischargeEars: R ear moderate waxy brown discharge, L ear nil erythema/dischargeOral: grade 1 dental disease, MM pale pink and moistCVS: grade 3/6 HM, nil arrhythmia, strong pulseResp: normal bronchovesicular sounds, nil nasal dischargeAbdo: soft, comfortable, no abnormalities palpableMSK: nil lameness, no pain/swelling noted, normal ROM all limbs, no pain on spinal palpation, moderate muscle wastage over body - more pronounced hips + spine, but also noted along shoulders + sagittal crestInteg: Thinning, rough coat, almost complete hair loss over HLs, ~2mm round raised red cutaneous lump ventral bellyNeuro: normal mentation, no obvious deficitsUrogen: no obvious abnormalitiesLNs: popliteal, prescapular, mandibular WNLLaboratory: Bloods taken for TAHPC, urine sent for urinalysis (end of day, no time to run in house, free catch)Assessment: Suspicion of Cushings high, cannot rule out other liver/kidney/metabolic disorders, need to assess for UTI etcConcerned that lump is HSA given history - can't anaesthetise until suspect Cushings is under controlPlan:TAHPC + urinalysis today, briefly discussed Cushings w O. If results suggest Cushings, LDDST next step, O okay with this plan, but will be pending blood results. Need to send estimate for LDDST--- 25/02/2026 11:42:40 AM KHB:Examinations - 24/02/2026 11:42:22 AM DLW Deferred: NN to callwith IDEXX CJ Resolved -    Vital Signs    Weight: 14.5;