C09997228 / invoice 10000

Reason: Idexx Oc Appointment Notes: Overdue reminders--- 06/03/2026 13:36:16 NSI: TAHP results> Complete Blood Count- Significant findings:  - Mildly elevated haemoglobin: 208 g/L (ref 134-207).  - Mildly elevated haematocrit: 0.60 L/L (ref 0.35-0.57). > Biochemistry- Significant findings:  - Moderately elevated ALP: 443 U/L (ref 1-150).  - Mildly elevated AST: 211 U/L (ref 18-80).  - Moderate to markedly elevated ALT: 794 U/L (ref 16-90).  - Mildly elevated CK: 650 U/L (ref 73-510).  - Mildly elevated cholesterol: 11.9 mmol/L (ref 3.5-9).  - Markedly elevated GGT: 129 U/L (ref 0-9).- Sample appearance: Moderate haemolysis noted. Lipaemic sample. DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Differentials for elevation in GGT, ALP and ALT include:- Liver disease with intrahepatic cholestasis: infectious, inflammatory, toxic, vascular, malignancy, primary inherited, hypoxia.- Extrahepatic cholestasis: pancreatitis, biliary disease, strictures, mucocoele, gallbladder stones, cholecystitis, biliary cancer.- Metabolic disease/secondary hepatopathy: steroid induction, Cushing's disease, hyperthyroidism, diabetes, hepatic lipidosis. ASSESSMENT:Bella has significant elevations in her liver enzymes (ALT, ALP, GGT) found on pre-anaesthetic screening. This increases the risk associated with a general anaesthetic. Further investigation with an abdominal ultrasound is recommended to determine the underlying cause before proceeding with a non-urgent procedure like a dental. Differentials are broad and include primary liver disease, toxic insult,  extrahepatic biliary disease, and secondary hepatopathies. PLAN:Two options to offer owner:1.  Abdominal ultrasound on the day of the scheduled dental procedure. If the ultrasound is unremarkable, proceed with the general anaesthetic and dental.2.  Postpone the dental. Commence a trial of hepatoadvance and recheck bloods in one month.It is not advised to proceed with a general anaesthetic without further investigation. CLIENT COMMUNICATION:Called client, no pick up. Left voicemail to call back.--- 06/03/2026 14:06:40 NSI:CLIENT COMMUNICATION:Discussed the significant elevation in liver enzymes and the associated increased anaesthetic risk. Explained the two options: proceeding with an abdominal ultrasound prior to anaesthesia, or postponing the procedure and starting a liver supplement followed by recheck of bloods. The owner elected for the second option. The plan to trial Hepato-Advanced for four weeks and then recheck bloods was confirmed. Advised that the dental procedure for Thursday is cancelled. A text message will be sent to the owner when the supplement is ready for collection. Asked if any access to any liver toxins such as cycads or panadol, owner said no access to liver toxins. Owner reports she is well at home. Only has very infrequent vomits. PLAN:- Hepato-Advanced (medium and large dog formulation), one tablet orally once daily for four weeks. Give on an empty stomach. - The planned dental procedure has been postponed.- Recheck bloods in four weeks to assess liver enzyme trends.- Re-evaluate the plan for the dental procedure based on follow-up blood test results.- To present to vet if any deterioration at home.--- 06/03/2026 14:09:54 NSI:Have placed in client orders. Nurse to text owner when ready to pick up.    Vital Signs