C09997521 / invoice 10000

Appointment Notes: admit for u/sAdmit time: 10amEstimate?:  receivedProcedure Q's?  nonePre/post op text received? Any Q's? sent upon phone callSigns of illness? noneFasting reminder: Food 10pm & Water 7amNurse initials: DSAppointment Notes: admit for u/sAdmit time: 10amEstimate?:  receivedProcedure Q's?  nonePre/post op text received? Any Q's? sent upon phone callSigns of illness? noneFasting reminder: Food 10pm & Water 7amNurse initials: DSultrasound for investigation of elevated ALP 1269. maybe drinking more the last 6 months but water intact is normal (62/kg/day). urination normal but dilute USG (1.022) with borderline proteinuira (0.5). No other signs of potential cushings disease. cx: BAR, eyes clear. ears cleanmouth - mm pink and moist. CRT 1-2sec. grade 2-3/4 tartar generalisedheart clear. HR 80bpm. no murmur or arrthymia. lungs clear in all fields. panting. abdomen tense and difficult to palpate due to weight. unable to feel individual organsperipheral Lymph nodes normalBCS 8/9temp 38.5diagnostics:sedated 10mcg/kg medetomidine and 0.2mg/kg butorphanol IV to good effect. Abdominal ultrasound was performed.Urinary bladder: unremarkable. Normal trigoneLeft kidney: normal architecture and echogenicity. 6.71cm longitudinally, normal renal pelvis. Right kidney: normal architecture and echogenicity. 6.86cm longitudinally, normal renal pelvis. Spleen: normal architecture and echogenicity. 15.8mm diameter at hilus. Liver: normal architecture and echogenicity. Hypoechoic to spleen. Sharp tapering margins. Gall bladder: normal architecture and echogenicity. Normal GB wall. anoechoic bile. Cystic and common bile duct: Not visible. Lymph nodes: LMILN 5.2mm, RMILN 5.7mm. mesenteric lymph nodes 4.1-4.2mm normal fusiform shape. Visible gastrointestinal tract: demonstrates normal layering, motility and thickness.Colon 3.3mm, Stomach empty, stomach wall 2.7mm, normal pyloroduodenal junction. duodenum 5.0mm, duodenal papilla 3.5mm height, jejunum 4.0-4.4mm, ICCJ normal, ilium 2.7mmPancreas: unremarkable. left limb 11.2mm diameter. Right limb 12.1mm diameter. isoechoic to surrounding mesentery. Left adrenal: normal architecture and echogenicity. 4.3mm caudal pole, 4.1mm cranial pole. Right adrenal: normal architecture and echogenicity. 4.2mm caudal pole, 4.0mm cranial pole. Other findings: NAD. No free fluid Interpretation:Normal abdominal u/sRecommendations:Recommend LDDST given increased drinking and dilute urine. 33-53% chance of having cushings disease based on JVIM paper  if polyuric and USG <1.020. alternatively monitor for a month and recheck 24 hour water intake at home in 1 month. ok to have a dentaldiscussed with owner. decided to start with a urine cortisol: creatinine ratio. if negative will reassess possible cushings signs in 3 months. if positive will have to do LDDST. must get urine for UCCR at least 5 days apart from a stressful event (next wednesday or friday). first morning sample ideally    Vital Signs    Weight: 23.7;       HeartRate: 80;       Temperature: 38.5;       

urinalysis (free catch): 5.30am. USG 1.022, pH 5.0, 1+ protein, -ve blood, -ve bilirubin, -ve ketones, -ve glucose. sediment:  inactive. < 1phpf WBCs, < 1phpf RBCs, no bacteria, no crystals, no casts.can last all night without urinating. drinking more in last 6 months. no obvious polyphagia. 24kg 12 months ago so has lost weight. walking her 5km a day now instead of just 1-2 times a week.no panting. exercise tolerance good. plan: owner monitoring 24 water intake and will let us know. UPC pendingdepending on results recommend abdo u/s. +/- LDDST after u/sowner communication 3-3-26UPC 0.5 (borderline)water intake 1.4L Friday-saturday  62mls/kg/day1.2L Saturday-Sunday 53.3mls/kg/dayplan: recommend going ahead with abdominal u/s.     Vital Signs    

Appointment Notes: Cohat AAdmit time: 8amEstimate?: dental handout in consultProcedure Q's? nonePre/post op text received? Any Q's? received no questionsSigns of illness? noneFasting reminder: Food 10pm & Water 7amNurse initials: DSPre-GA bloods done: Noteworthy findings (Marked elevation in ALKP **1222)Called Gregory to discuss findings - advised that an elevated ALP can indicate a number of things including primary liver dz - infectious, inflammatory, secondary - pancreatitis, gastroenteritis vs  toxins vs neoplasia vs metabolic dz (cushings, DM, hepatic lipidosis), drug induced.Advised would like more information as we only did a prep profile inhouse.  Will require IDEXX TAHP and an inhouse UA.Discussed CSx of cushings - pu/pd, ravenous appetite, pendulous abdomen.  O said that Holly has always been a big drinker, at this stage, is able to hold her bladder overnight.  Loves her food, but O only feeds 1 meal at night, and is quite strict with her.  Walked 5km a day, however, still unable to lose any weight.Gave verbal consent to run further tests.Once the results come back, and there is high suspicion for HyperA, next steps would be abdominal u/s with LDDST.Inhouse Urinalysis:Sample collected at  am/pm   via: urine sample pending as unable to collect any in clinic.  sent home with urine collection container with instructions, and O to drop in fresh urine sample tomorrow morning. USG:LEU:NIT:pH:PRO:GLU:KET:BIL:UBG:ERY:Hb:Cytology :Plan: urine sample pending, and IDEXX bloods pending.    Vital Signs    Weight: 22.5;       HeartRate: 104;       Temperature: 38.5;