C09987317 / invoice 10000

REASON: Vomiting and bloody urineTime: 22:40AES Vet: Dr Madeleine HearndenRegular clinic: SVCHISTORY:- Presented for vomiting and haematuria.- Seen by regular veterinarian earlier today for haematuria. Sent home with an Illium Neocort cream to apply to perivulval region and instructions to collect a urine sample.- Vomited after returning home from the regular veterinarian. No prior vomiting reported.- Behavioural changes noted this afternoon, described as erratic, alternating between high energy and severe fatigue. Unusual agitation noted, particularly about going outside. Seems extremely irritated by vulva.- Owner noted blood and mucus in the urine sample collected.- Symptoms first noted yesterday.- Increased urinary frequency, including urinating on the floor which is unusual. History of posturing without urination yesterday.- Poor appetite for a few weeks, described as very reduced. For example, breakfast is still present at nighttime.- Past medical history of vaginosis as a puppy, which resolved with gabapentin- No current medications or supplements.- Diet is a combination of Supercoat wet and dry food. No recent dietary changes.- Owner reports no other health problems.TRIAGE:Mentation: BAR, distressed, lovely dogHR: 120 bpmRR: 30 brpmTemp: 38.5 degCMM: Pink and slightly tackyCRT: <2 secPulses: normalPeripheral temperature: warmEXAMINATION:Weight: 23 kgBody Condition Score: 5/9Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: clear lung sounds auscultated bilaterally, respiratory effort normal, no nasal dischargeNeurological: appropriate mentation, no obvious cranial nerve to proprioceptive deficits, full neurological examination not performedMusculoskeletal: ambulating normally without gait abnormalities, full MSK examination not performedGastrointestinal:- Oral: unremarkable- Abdomen: Moderate to severe pain on palpation of the bladder region. Abdomen is tense on palpation. No pain elicited on palpation of the kidneys.- Rectum: no rectal examination performedUrogenital: Small, painful bladder on palpation. Permitted deep palpation, no stoned/grittness/crepitus noted on transabdominal palpation. Hooded vulva noted, evidence of excessive kicking and moisture.Integument/Ears/Eyes: Wearing appropriately-sized e-collar. Constantly turning to lick at perineal region.Lymph Nodes: peripheral lymph nodes normal size/shape and not painfulPROBLEM LIST:- Haematuria- Dysuria- Pollakiuria- Periuria- Vomiting (once)- Reduced appetite- Behavioural changes (lethargy, agitation)- Suspected urinary tract infection with rod bacteria- Severe alkaluria (pH 9)- Struvite crystalluria- Hooded vulva- Painful bladderASSESSMENT:1. Suspected Urinary Tract Infection (UTI)- Severe signs of a lower urinary tract infection are present. Urinalysis confirms a severe infection with a very high pH, presence of rod bacteria, protein, and blood. Struvite crystals are present, which are commonly associated with alkaline urine and infection. Uncertain if large amount of mucus is affecting pH reading. A hooded vulva may be a predisposing anatomical factor permitting retrograde movement if bacteria via the urethra. Kidney infection (pyelonephritis) is a differential, but less likely given the absence of fever and kidney pain on palpation, although the history of being unwell for a few weeks is noted, and sometimes pyelonephritis can be found even in seemingly well animals.- Recommended diagnostic tests include a biochemical analysis to assess kidney function and overall health, and urine culture and sensitivity on the free-catch sample to identify the specific bacteria and guide antibiotic therapy. Discussed that a free-catch sample may have contamination but is still valuable. Alternatiely offered to- Treatment plan involves initiating empirical broad-spectrum antibiotic therapy pending culture results, along with multimodal pain relief and anti-nausea medication.- Follow-up care will involve a recheck with the regular veterinarian within 7 days with a repeat urinalysis.- Consider radiographs for possible urogenital stones.CLIENT COMMUNICATION:Discussed the findings of the physical examination and urinalysis at length. Explained that the clinical signs and urinalysis results are highly indicative of a severe bacterial urinary tract infection. The significance of the bacteria, alkaline urine, and struvite crystals was explained. The possibility of bladder stones was mentioned as a differential, and radiographs and/or ultrasound needed to check for this. The role of the hooded vulva as a predisposing cause was also discussed, including the option of a vulvoplasty in the future if UTIs become recurrent.Options for management were discussed, including outpatient treatment versus hospitalisation for intravenous fluids and medications. The owner was counselled that while hospitalisation is an option, outpatient management is reasonable at this stage. The owner has elected to proceed with outpatient management, including blood work and urine culture.A cost estimate was provided for the consultation, diagnostics, and medications, which the owner has approved. Total was estimated to be around $1000.Discussed the plan to administer initial injections for pain relief and nausea in the clinic and to dispense oral medications for home care. All results and notes will be forwarded to the regular veterinarian for follow-up. The owner was advised on signs of deterioration and when to seek further veterinary attention.DIAGNOSTICS:1/ Urinalysis- Free catch sample collected by owner from home, dated today (2/3/2026)- Opaque, red-brown, highly mucoid. Extremely malodorous.- Very large mucoid & RBC pellet, but no haemoglobin/discolouration of supernataant noted- pH 9+ (as high as scale does)- USG 1.044- Dipstick - positive blood & protein, all else negatvie/normal- In-house sediment microscopy - Numerous rod bacteria +++++ (both intracellular in neutrophils and extracellular), erythrocytes ++++, small struvite crystals ++, no casts seen- Urine culture & sensitivity - PENDING - the free-catch sample of urine sent to Vetnostics early following AM1/ Biochemistry- Unremarkable - all parameters within reference intervalsTREATMENT:- Methadone 0.2 mg/kg IM- Maropitant 1 mg/kg SQ aPLAN:- The urine sample will be sent to Vetnostics in morning for culture and sensitivity. Results will be forwarded to the regular veterinarian.- A recheck examination is recommended within 7 days with the regular veterinarian. The owner was provided with a urine collection kit and advised to bring a fresh morning sample to this appointment. Advised to withhold food on the morning of the recheck in case sedation is required for examination or further diagnostics. Recommended radiographs for possible urinary stones in light of struvite crystals seen.- Medications prescribed:- Amoxyclav 500mg PO BID q12hr- Meloxicam 0.1mg/kg PO q24hr, to be started once provided Dottie is eating and not vomiting.- Paracetamol 375mg (3/4 of a 500mg tablet) PO q8-12hr as needed for pain relief- Patient education and counselling:- Discussed the importance of administering all antibiotics as directed.- Advised to hold the meloxicam if not eating or if vomiting occurs.- Discussed using paracetamol as an adjunct for pain control if required. The owner was also advised they can use their existing gabapentin (dose two to three times daily) for additional analgesia and sedation if agitation is significant.- Recommended to hold the application of neocort cream for now unless otherwise directed to do so upon rehcheck. If the perineal area appears very red and irritated, and this is not resolving with the e-colar preventing licking, they can reconsider its use, but the preference is to avoid adding extra moisture to the area in case that is exacerbating the moisture and irritation felt by Dottie.    Vital Signs    Weight: 23.2;