C09984062 / invoice 10000

Reviewer

Species:CANINE

Breed:Maltese Cross

Age (years):11

Diagnosis or signs:Hyper A, post acth, licking at foot

Consult notes

Revisit (Hypera /Post ACTH cortisol ). Licking at left fore foot. 

History:
(Tilly is stable. Good appetite and drinking alot as norrmal for her. )
Appetite (v good )
Drinking (large drinks each time but normal for her)
Current Medications (Trilostane 40 mg sid am)

Examination:

eyes:(mild conjunctivitis as previous. Bilateral nuclear lens sclerosis)
ears:(n)
mm:(p)
CRT:(1s)  

cardiac auscultation:(n)
pulmonary auscultation:(Mild URT referred sounds. )
femoral pulses:() 
abdominal palpation: (pot belly as usual for her)
lymph nodes:(n)
BCS:()
FAS score 0-5:(0)
Small abscess or ? furunculosis. btw digits LF 3 and 4. 

Assessment:
(Going well. ? Foreign body penetration btw toes. )

Plan:
(5ug/kg ACTH, 0.2 ml synacthen 4.5 hours post am Trilostane dose. [Aim for aroundd 4 hour post dose]. 
Blood Cortisol level 1 hour post to Gribbles. 

Lance and clean lesion btw toes. Bloody purulent material like small abscess, good probe with forceps, no fb found. Likely has had a puncture. 
Saline flush. Home with antibiotics. )

Animal clinical history (3 most recent)

2026-03-04T00:00:00Z 11:04:00

Revisit (Hypera /Post ACTH cortisol ). Licking at left fore foot. 

History:
(Tilly is stable. Good appetite and drinking alot as norrmal for her. )
Appetite (v good )
Drinking (large drinks each time but normal for her)
Current Medications (Trilostane 40 mg sid am)

Examination:

eyes:(mild conjunctivitis as previous. Bilateral nuclear lens sclerosis)
ears:(n)
mm:(p)
CRT:(1s)  

cardiac auscultation:(n)
pulmonary auscultation:(Mild URT referred sounds. )
femoral pulses:() 
abdominal palpation: (pot belly as usual for her)
lymph nodes:(n)
BCS:()
FAS score 0-5:(0)
Small abscess or ? furunculosis. btw digits LF 3 and 4. 

Assessment:
(Going well. ? Foreign body penetration btw toes. )

Plan:
(5ug/kg ACTH, 0.2 ml synacthen 4.5 hours post am Trilostane dose. [Aim for aroundd 4 hour post dose]. 
Blood Cortisol level 1 hour post to Gribbles. 

Lance and clean lesion btw toes. Bloody purulent material like small abscess, good probe with forceps, no fb found. Likely has had a puncture. 
Saline flush. Home with antibiotics. )

Previous claim history (15)

Date	Claim #	Diagnosis
2026-02-27	C09963224	CUSHINGS DISEASE
2025-12-30	C09749240	CUSHINGS DISEASE
2025-12-24	C09672101	HYPERADRENOCORTICISM ("CUSHING'S")
2020-07-16	C3033619	EAR (AURAL) INFECTION
2020-03-10	C2843230	EAR INFECTION
2020-02-19	C2738071	EAR INFECTION
2019-10-28	C2534845	BLOOD IN FAECES
2019-08-03	C2387382	SKIN CONDITIONS
2019-04-15	C2208157	EAR INFECTION
2019-04-01	C2155814	EAR (AURAL) INFECTION
2019-03-25	C2145309	EYE CONDITIONS
2019-01-10	C2036118	EAR INFECTION
2018-03-02	C1575680	RED EYE - PRESENTING COMPLAINT
2017-12-30	C1467173	FOREIGN BODY
2017-09-27	C1375875	EAR INFECTION

Line items(lines with upstream diagnosis are skipped by the model)

Line	tstarc	Amount	Date	Upstream diagnosis
10000	tstarc_consultation	123.00	2026-03-04	—
20000	tstarc_procedure_fee	95.60	2026-03-04	—
30000	tstarc_diagnostic_test_-_cortisol	68.30	2026-03-04	—
40000	tstarc_antibiotics_-_amoxicillin_and_clavulanic_acid	35.60	2026-03-04	—

UPM+

DG02293HYPERADRENOCORTICISM ("CUSHING'S")DSTP_hyperadrenocorticism_(cushing's_disease)

Variant (sleepy_king)

ABSCESS

DSTP_abscess_-_unspecified

Conf: 0.540

Threshold: 0.53

Above: ✓

Correct?

Yes No

Reason (correct)