C09999035 / invoice 10000

HISTORY: 05 Mar 05:41pm AC

HISTORY -
- Has been going to litterbox to urinate a lot over the last 1-2 days
- Still passing large amounts of urine at time, other times small amounts + straining; urinating 4+ times in an evening
- Saw some urine in bath tub with a tinge of blood today
- Still eating + drinking normally, still acting himself 
- O mixes water into food and has added extra since this started
- On Monday (3 days ago) used a very loud spot carpet cleaner -- he freaked out and hid all day long. Also went to vet for vaccinations on Monday.
- No history of prev urinary issues

EXAMINATION -
BAR, confident cat
BCS 4/9
Ears/eyes/nose NAD
MM pink, moist
Oral - perfect teeth
LNs WNL
HR 164, no murmur
RR WNL, normal resp sounds 
Abdo palp: soft abdomen, bladder size of a small lime, uncomfortable on bladder palpation
MSK NAD
Integument NAD

URINALYSIS -
USG 1.014 -- abnormally dilute
Proteinuria
Haematuria 
No bacteria

ASSESSMENT -
1. Feline idiopathic cystitis -- gave handout and discussed sterile / stress cystitis. Short term aim is to reduce discomfort. Long term aim is to reduce stress, provide enrichment, anticipate stressful events. Episodes typically last 3-7 days and reoccur during periods of stress.
2. Talked through drug options to take home today: (1) Meloxicam -- to use during active FIC episodes for pain relief / anti-inflammatory, (2) Gabapentin -- pain relief + anti-anxiety, can use during FIC episodes and/or anticipated stress, (3) Cystophan urinary supplement -- can use during FIC episodes or during times of anticipated stress or ongoing as maintenance supplement. Owners wanted to take gabapentin home, declined meloxicam as worried about kidneys (read about it online), will order cystophan from petcircle overnight shipping. 
3. Discussed urinary blockage risk at length

PLAN -
1. Gabapentin 100 mg capsules -- give 1 capsule 2 hours prior to stressful event or SID to BID during cystitis episodes (will cause sedation). 
2. If owners change mind, OK to dispense meloxicam 15 ml bottle: "Give 1 ml on first day of treatment. Starting 24 hours later, give 0.5 ml ONCE every 24 hours for up to 4 days. Give with food. Stop this medication and call the clinic if Mouse has any vomiting, diarrhoea, dark stools or stops eating."
3. Owners to order cystophan supplement for overnight delivery from pet circle. Follow directions on bottle.
4. Switch to wet food only with extra water mixed in during FIC episodes.
5. Monitor urine production during FIC episodes. If Mouse ever starts straining unproductively, seek veterinary attention immediately as urinary blockage is a life threatening emergency.
6. If FIC symptoms last longer than 6-7 days, seek veterinary attention.
TEMP: 38.7
WEIGHT: 5.1