C09989178 / invoice 10000

Updated bloodsCKD - likely exacerbated with frusemide useRecommended reduce from TID to BID FrusemidePlan:Re-check in 1 monthRepeat bloods in 1 month with urinalysisCan add spironolactone - reduced efficacy in cats than dogs but can try to see if can help reduce frusemide usage to slow CKD progressionCan also add potassium supplement due to hypok    Vital Signs    

Reason: ReviewAppointment Notes: Overdue remindersTID frusemideVerified: NoECN - 02/03/2026History:Presenting for: Leo, a cat with cardiac disease, presented for monitoring and blood work to assess kidney function while on cardiac medications.Historical Conditions:- Cardiac disease - currently managed with medications- Client has thrombocytopenia (blood disorder) following COVID, managed with anticoagulantsCurrent Meds:- Frusemide 3 times daily for cardiac disease- Cardisure 1 tablet BIDExamination:Behavioural: Described as a sweet boy, well-behaved during examinationAssessment:Cardiac disease - Patient stable on current cardiac medications but requires monitoring of kidney function due to potential adverse effects of Frusemide at current dosing frequency. Higher doses of Frusemide can affect kidney function, creating a balance between cardiac management and renal health.Plan:Diagnostics:- Blood work to assess kidney function and monitor for adverse effects of cardiac medications- Weight measurementChanges to Existing Meds/Tx:- Continue Frusemide 3 times daily as this dosing is helping with cardiac management- Continue Cardisure 1 tablet BIDAdditional Discussion:- Discussed potential alternative cardiac medications if kidney function deteriorates, though Frusemide remains most effective for feline cardiac patients- Will consult with colleagues regarding alternative medications that may be less nephrotoxic- Spironolactone discussed as potential addition but noted to be less effective in cats compared to dogsClient Comms:- Will call with blood work results and discuss potential medication adjustments if kidney parameters show changes- Will discuss adding alternative medications if warranted based on blood results and colleague consultation    Vital Signs    

--- 02/02/2026 12:07:29 ABM:O called back Leo is doing fine was a little unwell for a few days but back to normal now.    Vital Signs