C09984389 / invoice 10000

Reason: Any - UTI HISTORY:Cleo presented with blood in urine noted by owner. Owner observed actual blood clots separate from urine when Cleo urinated on pavement. Urine appears opaque. Cleo consciously passing urine, not dribbling. Owner reports Cleo has been less energetic and sleepy. Eating and drinking slightly less than usual but still maintaining appetite.History of recurrent UTIs with approximately six episodes to date. Last UTI was in December 2025, which occurred around the time of a hot spot and planned surgery. Previous urine culture in July 2025 grew E. coli. Currently on urinary dissolution diet.Current meds: noneParasite Prevention: Not mentionedPre-existing conditions: Recurrent urinary tract infectionsEXAMINATION:Demeanour/Behaviour: Happy demeanour despite illnessBody Condition Score: 5/9Eyes: no discharge or erythema bilaterallyIntegument/Ears: ears showing no discharge bilaterallyLymph Nodes: lymph nodes symmetrical and not palpably enlargedOral: no gingivitis or calculus notedCardiovascular: HR within normal reference range, no murmur or arrhythmias heard on auscultationRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeAbdominal: no detectable pain on abdominal palpation, no distension organomegalyNeurological: full neurological exam not done todayPROBLEM LIST:1. Haematuria with visible blood clots2. Opaque urine3. Recurrent urinary tract infections4. Decreased energy and appetiteDIAGNOSTICS:Urinalysis performed revealing severe findings. Very concentrated urine with two different types of bacteria present - rods and cocci. Numerous white blood cells identified causing chunky appearance of urine. No crystals visualised. Urine pH appropriate. Urine concentration in middle range raising questions about kidney function.Urine culture and sensitivity to be submitted to identify bacterial species and antibiotic sensitivities given recurrence and time since last culture.ASSESSMENT:Severe urinary tract infection with mixed bacterial population and significant inflammatory response. Given history of recurrent UTIs, investigation into underlying predisposing factors warranted. Differential considerations include anatomical abnormalities, vesicoureteral reflux, or other structural issues predisposing to bacterial retention. Concern for potential ascending infection to kidneys given recurrent nature.TREATMENT:Antibiotic therapy prescribed - one tablet twice daily. Urine sample submitted for culture and sensitivity testing.PLAN:Abdominal ultrasound recommended to evaluate urinary tract anatomy and kidney functionBlood testing to assess kidney function given recurrent UTIs and risk of pyelonephritisSedation likely required for ultrasound due to handling sensitivityOwner to consider insurance pre-approval for ultrasound costs (approximately $1000)Internal medicine referral discussed as alternative option for more comprehensive urinary tract evaluation including cystoscopy (estimated $4000-6000)Continue urinary dissolution dietRecheck following culture results and antibiotic courseCLIENT COMMUNICATION:Discussed severity of current infection with mixed bacterial population. Explained concern regarding recurrent nature and need to investigate underlying causes. Reviewed options for further investigation including in-house abdominal ultrasound versus specialist internal medicine referral with cystoscopy. Cost estimates provided - ultrasound approximately $1000 versus specialist workup $4000-6000. Advised owner can submit estimates to insurance for pre-approval. Discussed benefits of current urinary diet and importance of ruling out anatomical predisposing factors before considering long-term antibiotic management strategies.    Vital Signs    Weight: 21.3;