C09985195 / invoice 10000

Reason: Urinating a lotAppointment Notes: Paws App Details:Booking Type: ConsultationBooking Vet: - Any -Booking Notes: Urinating a lot Pet Insured: YesDiagnosis: suspect hormone responsive incontinenceTreatment: StilbesterolOne sid 3 fdyas then once a wekeVerified: NoHISTORYPresenting for: Bonnie, a spayed female Westie, presented for urinary incontinence with six separate incidents of urination inside the house over the past week.Historical Conditions: Previous history of recurrent urinary incontinence episodesDrinking/Urination: Six episodes of urination inside the house over the past week, occurring only when lying down or sleeping. No urination accidents when walking around. Normal urination when taken outside for walks with no straining.Diet: Eating well with healthy appetite. Restricted diet with good exercise to maintain weight.Current Meds: Up to date with preventativesEXAMMentation: BARBCS: Good weight maintenance despite being food motivatedBehavioural: Extremely food motivated dogASSESSMENTHormone responsive incontinence - Oestrogen deficiency causing urethral sphincter incompetence. Episodes occur only during deep sleep when stress hormone levels drop, leaving insufficient hormonal support to maintain urethral closure.PLANNew Meds/Tx:- Oestrogen replacement tablets: One tablet daily for first 3 days (Thursday, Friday, Monday), then one tablet weekly thereafter. Can reduce to half tablet weekly if effective. Treatment may be needed lifelong or short-term depending on response. Cost approximately $50 per year.Additional Discussion:- Condition occurs because desexed females rely solely on stress hormones to maintain urethral sphincter closure during sleep when oestrogen is absent- Alternative treatment with stress hormone supplementation available but requires twice daily dosing and costs $80 per month- Response to treatment should be evident within 2 days if diagnosis correctClient Comms:- If incontinence continues after Monday, alternative diagnosis should be considered- Can trial reducing dose to half tablet weekly once control achieved to find minimum effective dose    Vital Signs