C09998457 / invoice 10000

06/03/2026 Reason:  O concerned about toileting a lot and refilling water bowl more often
fatty lumps on chest

History: smaller lumps between forelegs checked previously
PU/PD seems to be the last month or two
had diarrhoea yesterday but fine today
seems to be good with appetite

Current meds: 
fluoxetine
Mentation: BAR
Body condition score:     6/9 above ideal
CRT/HR/RR/Temp/LN
Pink <2secs/normal/normal/normal/nad

Ocular:
Oral/Dental: stage
Ears: ne
Cardiovascular: nad
Respiratory: nad
Gastrointestinal: nad 
Integumentary & lumps: lump right flank, lump left flank,2 lumps between front legs
Musculoskeletal: enlarged left stifle but no crepitus or pain, hips ROM not bad
maybe some spinal pain
Urogenital: ne
Neurological: ne

Problem List:
PU/PD
ongong anxiety slightly controlled with fluoxetine
Assessment: 
O wants to continue with fluoxetine
advise bloods and urine to further work up PU/PD

Urinalysis:
active sediment blood bacteria WBC inflammation/infection
USG 1.002 - cushings? pyelonephritis?

Bloods:
severe leucocytosis with severe neutrophila and mild to moderate monocytosis
stress/corticosteroid leucogram vs infectious/inflammatory?
creatinine increased with normal SDMA and urea 
Treatment: 
Start on amoxicillin
Plan:
culture and sensitivity of urine?
abdo scan liver +/-acth stim test

TTPONALM to relay blood results