C09994920 / invoice 10000

Reason: Recheck TRA LHSAppointment Notes: Overdue reminders  ------- Sms reply: YesVerified: NoHistory:Presenting for: 18-year-old feline presenting for recheck of suspected dental abscess, L periocular chemosis and bloodwork.Historical Conditions: Heart murmur, previously diagnosed dental abscess. Diagonsed hyperthyroidism last year.Diet: Eating wellCurrent Meds: Liquid pain relief/anti-inflammatory medication once daily. Methimazole transdermal gel 2.5mg/click BID.Lifestyle Risk Factors: Indoor onlyExamine:Mentation: BARWt:BCS: 3/9T: Not TakenBehavioural: Quiet, gentleEyes: L ventral periocular chemosis reduced but not fully resolvedThroat: Thyroid slip palpableOral: Large hole where 108 tooth normally sits, suspected as dental abscess, unknown if any tooth remains without dental xrays. Cardiovascular: Fast HR 212, G2 systolic murmur, normal rhythmnAssessment:Resolving dental abscess - Improving but not completely resolvedHyperthyroidism - Thyroid slip palpable, E++ but no weight gainHeart murmurGeriatric patient - 18 years oldPlan:Diagnostics:- Bloodwork to check thyroid levels, kidney function, and electrolytes- Urinalysis - client to collect sample at home using non-absorbent litter- Blood pressure measurementAdditional Discussion:- Discussed importance of checking kidney function alongside thyroid levels as hyperthyroidism can mask underlying kidney disease- Explained that high thyroid causes increased metabolism, higher blood pressure, and increased workload on kidneys- Discussed that treating hyperthyroidism can unmask kidney disease as blood pressure normalizes- Discussed management options for dental issue - medical management vs. surgical intervention ( Os not keen on sx given age and concurrent ailments)- Noted that swelling is improving with current treatment- Discussed that anaesthetic risk is slightly increased due to heart murmurClient Comms:- Cost estimate for bloodwork, urinalysis and blood pressure: $360 (without cystocentesis)- Client provided with non-absorbent litter, syringe and urine collection pot for home urine collection- Client to bring urine sample as soon as possible after collection- Discussed potential for bacterial contamination in home-collected urine sampleBlood Pressure Measurements:1: 153/111 (125)2: 165/117 (132)3: 186/110 (135)4: 172/102 (144)5: 170/114 (132)169/111 (133) - AVERAGE - high normalBLOODSCrea low end normal - suspect due to low muscle mass +/- suppression from hyperT4TT4 43 -- target range on Methimazole: 20 to 40 nmol/L therefore high result todayRest wnlURINE Moderately concentrated USG 1.021 - no sign of dehydration/azotaemia so likely appropriateOtherwise unremarkable--- 28/01/2026 15:05:56 CLA:Call made by: CLASpoke with: Both OsReason: Thyroid test results discussionSummary:- Thyroid level is 43 nmol/L, slightly higher than desired for a cat with hypothyroidism on Methimazole- Kidney values: creatinine at lower end of normal range, possibly due to low muscle mass and thyroid suppression- Urine is moderately concentrated with no bacteria present- Blood pressure is high normal, not concerning currently - Current medication: one click (2.5mg) BID of transdermal Methimazole gel on each ear- Owners were away for 3 weeks (until January 5) and suspect medication wasn't properly administered at cattery- Cat had lost weight, has brown staining on paws, and appeared depressed after boarding- Owners may have missed a few doses after return due to jet lag- Thyroid level is not critically abnormal (43 vs reference range upper limit of 40)Action items:- Continue current dosing (one click BID) for two more weeks- Schedule recheck of TT4 level and chem10 in two weeks - send off TT4 to external lab pls- BP repeat in ~3 months (DOPPLER)- If T4 still not wnl then recommend switching to oral Thyronorm liquid (better absorption and accuracy of dosing / dose changes)Plan: Increase Methimazole dose by 2.5mg/day (dose TID instead of BID) and recheck these bloods in 3 weeks.Recheck BP in 3 months (doppler).--- 05/03/2026 12:32:38 GR: LMOM about outstanding account--- 06/03/2026 11:30:22 HC: attempted to call O, left voicemail and message sent about outstanding bill from 28/01 of consult fee of BP, bloods and urinalysis. To call back and pay, popped in nurse diary for tommorow as well incase do not call back to sort this.--- 06/03/2026 11:48:07 GH:Paid in full - have submitted claim to insurer    Vital Signs