C09991639 / invoice 10000

arh hx attached

Full check up. GAPONLY

PATIENT:
Kyppy

VISIT:
Reason: Check up

SUBJECTIVE:
History: Kyppy was presented today for a check up. The owner reports glaucoma in the left eye and right eye, on treatment from eye specialist since November. Woke Saturday morning with right eye packed closed, appeared in distress and painful. Taken to ARH West Gosford emergency, treated for pain. Eye specialist follow up yesterday - pressure was elevated at 60 at hospital but trending down at specialist. Since Saturday, both eyes on same treatment regime. Azarga three times daily in both eyes, Isathal twice daily in both eyes. Heart murmur noted to have progressed from grade 2 to grade 3 at emergency. Elevated ALT and kidney function tests noted at emergency - full hx not yet received, only summary. Hair loss and coat changes ongoing for almost two years. Previous discussion of possible Cushing's syndrome but urine test not completed. No increased drinking or urination. No weight gain. No pot belly appearance. No panting. Occasional cough when barking, seems to run out of air - tracheal collapse questioned at emergency. No exercise intolerance, runs around like a puppy. Left hind leg lifts when jogging, has done this since a puppy, skips a step, has not worsened. Previous skin irritation at beach with bleeding, hair grew back thicker and darker in that area. Multiple skin lumps present for years, one on neck under collar noted by owner for a couple of months, stable in size.
Current medications: zalatan BID both eyes and azarga TID both eyes, Nexgard monthly

OBJECTIVE:
Physical Exam:
General Appearance: Bright and happy
BCS: No pot belly, no weight gain
Eyes: Not painful, appear clear
Ears: Slight yeast odour, normal waxy discharge, no infection or irritation, not painful on palpation
Mucous Membranes: Pink, moist mucous membranes with CRT <3 seconds.
Teeth: Quite bad, most likely need many extractions  gr 4/4, severe calculus, gingivitis and gingival recession
Lymph Nodes: No abnormalities detected.
Heart/CV: Heart murmur grade 2-3
Resp: Chest sounds clear, normal respiratory rate and character. No significant findings on auscultation.
Neuro: 
Abdomen: Soft and palpable, no obvious masses and no signs of pain on palpation.
Skin/Coat: Hair loss and coat changes present. Multiple skin lumps - one on neck under collar noted for a couple of months, stable in size. Other lumps present for years, stable. Likely lipoma or age-related calcification/skin tags.
Musculoskeletal: Left hind leg - mild laxity on palpation, cannot elicit patellar luxation. Skips when jogging, stable since puppy.
Urogenital: 
Rectal: 
Temperature: 

Diagnostic Results: ARH report - elevated ALT (mild to moderate elevation, single enzyme, not severe), elevated kidney levels, heart murmur grade 2-3

ASSESSMENT:
Glaucoma both eyes - currently stable on treatment
Heart murmur grade 2-3 - progression noted
Elevated ALT and kidney levels - requires comparison with current bloods
Hair loss and coat changes - atypical presentation, lacks usual Cushing's clinical signs
Possible tracheal collapse - intermittent cough when barking
Left hind leg intermitten lameness - mild patellar laxity, stable
Multiple skin lumps - stable, likely benign

PLAN:
Diagnostic/Treatment Plan:
Full blood panel (haematology and biochemistry) plus urine cortisol:creatinine ratio to screen for Cushing's syndrome.
 Urine sample to be collected by owner tomorrow morning and dropped off. Results to be discussed next week after Tuesday.
Investigating specialist ultrasound options for abdominal organs and heart - may require day procedure or referral to specialist. SV to call with options next week.
Dental work to be considered once other investigations complete.

Recommendations: Continue current eye medications as directed by eye specialist. Monitor skin lump on neck. If any changes in demeanour or condition, contact clinic sooner. Follow up with eye specialist as scheduled.

Problems:
Glaucoma - zalatan BID both eyes and azarga TID both eyes
Appearance - cushingoid, no PU/PU
Murmur - gr2 noted here, gr3 noted at eye hospital
Elevated liver enzymes noted at eye hospital

Attache eye clinic report 


CLINICAL SUMMARY
Record Date:
02-03-2026
Referring Clinic: Green Point Veterinary Hospital
Dear Doctor,
Thank you for referring Kyppy, belonging to Melissa Neri of 108/79-91 Macpherson Street, Warriewood. I examined this
patient for you at the Eye Clinic for Animals at Artarmon, and found the following:
The medications listed in this summary may be dispensed by a veterinarian who has previously assessed the patient
and/or provided a referral. 
 History
Reason: recheck LEFT eye glaucoma
Owner reports:
Azarga BOTH eyes TID since Saturday night
Xalatan BOTH eyes in PM since Saturday night into the right eye
Other issues:
has a heart murmur recently diagnosed to be worked up
possibly kidney / liver issues as elevated AST
Examination: The right eye at this stage is totally normal. Some nuclear sclerosis and iris atrophy present as expected for a dog of this
age. Possibly some slight darkening of the optic nerve. Strong menace and dazzle reflex present. No obvious infarcts present.
Left eye is moderately oedematous and has had a previous grid keratotomy performed. The eye is permanently blind from chronic
glaucoma I suspect - dark optic nerve head.
IOP is 12 mmHg LEFT eye and 12 mmHg RIGHT eye
Diagnosis: blind LEFT eye from chronic glaucoma
Treatment:
Azarga BOTH eyes BID
Xalatan BOTH eyes SID in PM-glycerine 5-7 mls po BID as an emergency
Plan: drop off for IOP curve in next few days - have likely had a spike - will need surgery in all likelihood but not 100 % sure there was a
true spike.
Thanks for the referral and please call if there are any concerns
Yours sincerely,
OD= Right Eye, OS= Left Eye, OU = Both Eyes, PLR Pupillary Light Reflexes, IOP= Intraocular Pressure, IOL=Intraocular Lens
1 of