C09982494 / invoice 10000

check up & repeat bloods inc sdma LG

 Primary Diagnosis/Suspected Diagnosis- ongoing management hepatitis and renal
Suspect Cause- 
Any other conditions being treated (if any)  Nil
Known health concerns -
Date of first clinical signs(if known)
 BLOODS and PE to ASSESS PROGRESSION AND MANAGEMENT 

HISTORY
Presenting for: Dash, a 17-year-old small breed dog, presented for routine blood work to monitor liver and kidney values, with owner noting progressive hind limb ataxia over the last 6 months.

Historical Conditions:
- Elevated liver values (ALT, AST) approximately 2 years ago, significantly improved with home-cooked diet
- Liver lesions identified on ultrasound at VSS - monitoring for changes
- Mildly elevated SDMA on previous blood work
- Recent blood work in May and September showing kidney values beginning to increase
- Previous Zydax course completed around September with minimal improvement noted

Diet:
- Home-cooked organic diet for past 2 years as recommended by naturopath
- Appetite remains excellent
- Meal prep takes half day weekly
- Three meals daily with added water for hydration

Drinking/Urination:
- Water bowls take considerable time to empty
- Owner adds water to meals to ensure adequate hydration
- No observed excessive drinking noted by owner

Current Meds:
- Antinol: 1 capsule daily in morning meal
- Hepatic support tablets: 2 tablets for small dog/cat dosage in evening, given 1 hour before meal
- Various herbal supplements and liquid tonics as prescribed by naturopath

Other:
- Progressive hind limb wobbliness over 6 months, described as drunk-like ataxia
- Worse when first getting up from bed, improves slightly with movement
- Occasional limping during walks requiring owner to carry dog home, resolves after 1+ hours
- Spends increased time in bed with occasional depressed appearance
- Still excited and responsive when owner returns home
- Occasional yelping when picked up, random occurrence

EXAM
Wt: 4.9 kg
HR: 128 bpm
Behavioural: Stressed during examination, shedding excessively, resistant to oral examination
Eyes: Right eye - early cataract changes with glassy appearance and mild weeping. Left eye - nuclear sclerosis consistent with age
Oral: Dental disease present with thick calculus, resistant to examination due to stress
Cardiovascular: Strong heart sounds, no murmurs or arrhythmias detected
Respiratory: Clear lung sounds bilaterally
Abdominal: Comfortable on palpation, no reaction to liver palpation, soft intestines, mild tucking noted, hepatic silhouette palpable
Lymph Nodes: Right submandibular lymph node slightly larger than left, not significantly enlarged, no evidence of abscess
Neurologic: Ataxic gait observed, proprioception intact - appropriate response to knuckling test, delayed lifting response noted
Musculoskeletal: Joint effusion present in right stifle and both stifles, reduced range of motion due to discomfort, muscle mass stronger on one side, kyphotic posture developing, arthritis changes consistent with age
Diagnostics: Full geriatric blood profile including phosphorus levels to be sent to external laboratory

ASSESSMENT
Chronic kidney disease - SDMA elevated at 53.4, urea and creatinine increasing from previous results 24
Chronic hepatopathy - ALT elevated to 152,  (previously 150, 264), AST with short half-life indicating active liver cell damage, liver function parameters remain adequate
ALP- 257
ca 12
Azotaemia BUN 118 crea 2.5
Osteoarthritis - bilateral stifle effusion, reduced range of motion, age-related degenerative changes
Ataxia - likely neurological component rather than purely arthritic, proprioception intact
Dental disease - significant calculus accumulation, increased anaesthetic risk due to concurrent organ dysfunction
Age-related ocular changes - nuclear sclerosis and early cataract formation

PLAN
Diagnostics:
- Full geriatric blood profile including phosphorus levels submitted to external laboratory
- Urine sample collection recommended for specific gravity assessment and kidney function evaluation

New Meds/Tx:
- 4Cyte joint supplement recommended as loading dose for 4 weeks, then maintenance dose
- Consider CBD therapy at 1mg/kg if no improvement with 4Cyte after 6-8 weeks trial

Changes to Existing Meds/Tx:
- Continue Antinol, can increase to loading dose (2 capsules) during cooler months when arthritis typically worsens
- Discontinue Zydax due to lack of efficacy and limited scientific support

Additional Discussion:
- Avoid Loxicom due to kidney disease
- Gabapentin previously trialled with no benefit, likely due to neurological rather than purely arthritic cause
- Ketamine injection therapy discussed as potential pain management option with concurrent kidney/liver support
- Physiotherapy referral available at Tweed for massage, laser therapy, and hydrotherapy
- Acupuncture services available through same practitioner
- Maintain gentle exercise, avoid overexertion
- Dental procedure carries increased anaesthetic risk due to organ dysfunction
- Quality of life assessment discussed - monitor appetite, interaction, and demeanour when unobserved

Client Comms:
- Euthanasia discussion - framed as treatment option to prevent suffering rather than taking life
- Monitor for changes in appetite, drinking, and engagement as indicators of disease progression
- Recheck appointment in 6-8 weeks to assess response to 4Cyte and review blood work results
- Contact clinic with any concerns about deterioration in condition