C09988462 / invoice 10000

History: Southern Meloxicam + buprenorphine NO more blood NO urinatingHistory:Presenting for: Syd, a female cat, presented for follow-up of haematuria following recent emergency visit to Southern Animal Hospital where urinary blockage was treated.Historical Conditions:- Recent visit to Southern Animal Hospital for haematuria and urinary blockage - described as pretty intense- Known kidney stones (calcium oxalate stones suspected)- Previous blood results from 10/11: creatinine normal, SDMA elevated at 18 (normal range 0-14)- History of diarrhoea secondary to Meloxicam administration- Previous lupus-related condition affecting immune system- Multi-cat household with ongoing stress/anxiety due to inter-cat aggressionDrinking/Urination:- Drinks large amounts of water (2 bowls daily)- Urination frequency once to twice daily with large volume (3+ litres)- Blood in urine with chunky, jelly-like consistency- Currently has urinary catheter in place making assessment difficult- No increased urination frequency notedV/D/C/S:- Diarrhoea this morning following Meloxicam administrationCurrent Meds:- Meloxicam (causing diarrhoea, to be discontinued)- Opiate painkiller (Buprenorphine) - small doses- Probiotics at home (Pro-Kolin type, shelf-stable)- Cranberry extract supplementLifestyle Risk Factors:- Multi-cat household with 2 other cats- Significant inter-cat stress - other cat corners patient at litter box and attacks when vulnerable- Environmental stress contributing to urinary issuesExamination:Wt: 5.4kgBehavioural: Terrified of veterinary procedures, particularly urine collectionUrogenital: Bladder palpated for urine sample collectionDiagnostics: Urinalysis performed - 4+ blood present despite clear appearance, acidic pH, not well concentrated, rod-shaped bacteria present throughout sample indicating bacterial urinary tract infectionAssessment:Bacterial urinary tract infection - Rod bacteria identified on urinalysis with 4+ blood present. Likely secondary to underlying kidney stones and exacerbated by inter-cat stress causing feline idiopathic cystitis component.Meloxicam-induced diarrhoea - Gastrointestinal upset secondary to NSAID administration in patient with potential renal compromise.Plan:New Meds/Tx:- Convenia injection administered - 2-week duration antibiotic, avoids gastrointestinal tract to prevent worsening diarrhoea- Buprenorphine on file as backup analgesia if discomfort increases - sublingual administration, very safe, can cause mild sedationChanges to Existing Meds/Tx:- Discontinue Meloxicam immediately due to diarrhoea and potential renal concerns- Continue probiotics at home for diarrhoea management- Continue cranberry extract supplementAdditional Discussion:- Rod bacteria have tendency for antibiotic resistance, may require culture and sensitivity if treatment fails- Urine culture costs approximately $250-300 but reasonable chance Convenia will be effective- Stress component significant factor - discussed feline behavioural specialist YouTube video for inter-cat aggression management- If prednisolone needed for anti-inflammatory effects in future, safer option than Meloxicam given renal concernsClient Comms:- Return 24/03 (Tuesday) for recheck urine sample 17-18 days post-Convenia (3 days after antibiotic completion)- Can schedule early morning appointment- Contact clinic if symptoms worsen or blood/discomfort increases before recheck- May need urine culture if bacteria persist on recheck- Discussed stress management strategies for multi-cat household dynamics    Vital Signs