C09988333 / invoice 10000

Reason: Exam And VacVerified: YesHistory:Primary concern is intermittent coughing episodes described as honking bark that can go on for a very long time, disturbing sleep. Episodes haven't occurred for about a month but were previously very bad. Patient was treated with codeine (cough suppressant) which helped while on treatment. Short episodes now occur with exercise or overexcitement, but main concern is nighttime coughing episodes where patient wakes up coughing for extended periods.Patient showing decreased energy levels and increased lethargy, though still excited for walks and play. Mobility changes noted - hesitant going up/down stairs unless watched, sometimes runs into bed instead of jumping up, refuses to use provided stairs.Appetite has increased - now eating daily whereas previously could go 2 days without eating, though still somewhat picky and doesn't finish meals in one session. Drinking more water than previously. Urinating more frequently including accidents on carpet upstairs, and on walks urinates instead of just lifting leg.Weight loss from 5kg in November to 4.8kg currently (normal weight around 4.5kg).Parasite control: NexGard Spectra monthlyDiet: Kibble alternating with Hill's Science chicken stew wet food, with probiotic powder on wet food every other daymedications: Probiotic powder every other dayExamine:BARMM pink/moist CRT 1-2s, minimal plaque tartarEyes - clearEars - clearDental grade - grade 0.5/4HR=PR. No murmur/arrhythmiaAll lung fields sound clear. Normal RE. No cough on tracheal pinch. Abdomen soft and comfortableSkin - normal hair coat, RFL dorsal aspect there is a small soft raised pink/ light grey coloured mass approx 1cmAmbulatory - no lameness or ataxia, full ortho exam not performedAssessment:- Intermittent coughing episodes - likely upper respiratory tract disease, possibly collapsing trachea/ DAD- Weight loss, increased drinking and urination - rule out Cushing's disease or diabetes- Previous elevated ALP levels (267 in May, 310 in June) - Skin tag on RF paw - changed colour, previously frozen off and regrown. Likey adenoma. Offered cytology today. O happy to monitor. Will possibly sample if going to sedated chest rads. - Chronic gut sensitivity - consider B12 deficiency. Treatment:No treatments administered today. Hold on vaccinations for now. Plan:- Blood work to check for Cushing's disease, diabetes, kidney and liver function, and B12 levels- Urine sample collection at home (first morning sample preferred, store in fridge if delayed)- Results discussion tomorrow via phone- Consider chest X-rays if indicated based on blood work results- Vaccinations postponed until health status clarified - If sedation required for X-rays, can address skin tag surgically at same time if desired    Vital Signs    Weight: 4.81;