C10002160 / invoice 50000

Appointment Notes: v+ & d+ after eating muesli bars, urinating in the houseO reports 2 weeks ago starting urinating in the house - approximately four times on separate occasionsUsually occurring during the nightVolume of urine large; no blood or straining seen No evidence of incontinence Unsure re drinking volumes Six days ago ate two muesli bars from pantry (has done this before); however, had 48 hours of diarrhoeaOn Monday also ate unknown quantity of macadamia and cashew nuts - began vomiting over the next 48 hours, mainly bile and not associated with eatingAppetite good, maintained despite GI symptoms Last vomit Tuesday, and diarrhoea has resolved No lethargy observed at home Diagnostic:UA - unable to collect urine in clinic; O will collect at homeGHP:CREA 144umol/L [27 - 124]BUN 9mmol/L [2.5 - 8.9]AMYL 1398 u/L [200 - 1200]TP 44 g/L [54 - 82]GLOB 23 g/L [23 - 52]Plan:- Rx SDMA to lab- Assess urine with USG, dipstick, wet prep and gram stain for UTI- May need to also run UPC to assess for protein loss UA:USG 1.018Moderate non-haemolysed bloodTrace protein Positive leucocytespH 6All other values negative/normal Plan:- Send urine off for culture and sensitivity - If no growth, consider repeat urine sample to assess for blood prior to sending off for UPC- Start on Hills k/d diet - Consider Stilbesterol for incontinence management - Repeat bloods 2 months 12/11/2025 12:43:10 PM HC:CULTURE >10,000 CFU/mLIn CANINE urine, the following numbers of CFU/mL are consideredprobable contaminants: cystocentesis - <100 CFU/mL; catheterised -<1000 CFU/mL; voided <10,000 CFU/mL.Type Growth of #Aerobic Non haem E. coli 1Sensitivities Ampicillin RCefovecin SCephalexin SClavulox REnrofloxacin SMarbofloxacin SSulphatrimethoprim SResults reported to Annette.Rx Cephalexin 600mg bid x 7d.Rpt UA @ end of course - in house dipstick/SG initially, extend AB course if still indicators of infection.usg 1.026 trace blood pH 6Advised owner Trace blood May represent residual inflammationUrine concentration betterOwner reports incontinence appears to be under controlStart KDRevisit two months repeat bloods and repeat urineO reports ongoing, intermittent diarrhoea since starting k/d diet as prescribed last visit for early CRD Within a couple of days of adding a small amount of k/d food to normal diet (Hills Metabolic) developing diarrhoea Stopped the k/d food and restarted normal diet Since then intermittent, ongoing diarrhoea - no blood, but mucousy Last 7 days has had persistent diarrhoea, defecating in the house Still eating well, normal drinking/urination, no vomiting or lethargyDoes get toast crusts (but always has)UTD with Nexgard SpectraO noticed drinking bowel had algae growth in it tooTreatment:- Pro-kolin BID PO until faeces formed - INI next 36 - 48 hours, start Amoxyclav 500mg BID PO 7 days- Small meals chicken and rice only until faeces formed, then slow reintroduction of normal food over 2 - 3 days- Novasone lotion SID both ears 5 - 7 days, then up to TIW as required + perianal region (monitor)Plan:- Faecal PCR to lab- If ongoing diarrhoea despite conservative treatment, rx repeat bloods + abdominal US- Once faeces return to normal, elect to trial k/d again --> if gastro symptoms recur, may need alternative diet - Monitor for vomiting/lethargy/inappetence Faecal PCR:Clostridium perfringens Toxin A DNA DETECTEDClostridium perfringens CPE Toxin DNA DETECTEDPCR for Clostridium perfringens A is of uncertain value in dogs with diarrhoea as this target is identified in similar percentages of dogs with or without diarrhoea. In one study, Clostridium perfringens A was identified in 84% of dogs without diarrhoea and 91% of dogs with diarrhoea.PCR for Clostridium perfringens CPE was positive in 15% of dogs without diarrhoea and 17% of dogs with diarrhoea in one study and may be of limited value in assessing most cases of diarrhoea in dogs. However, Clostridium perfringens CPE toxin production, as well as netF toxin production, may be associated with acute haemorrhagic diarrhoea syndrome (AHDS), with Clostridium CPE reported to be positive in 67% of dogs with AHDS. The presence of Clostridium perfringens CPE gene in a case with supportive clinical signs may be significant.STO: O started oral antibiotics yesterday as there was no improvement with the bland diet and Pro-kolinHas not seen urgency to defecate after starting antibioticsAdvised continue Pro-kolin for a few days after faeces formedIf stools improving but not approaching 100%, extend Amoxyclav course another 7 daysIf stools nearly 100% after oral antibiotics, continue Pro-kolin for 3 - 5 days Diarrhoea resolved 7 days agoFinished second course of Amoxyclav + Probiotic Slowly introduced normal diet (Hills Metabolic from chicken + rice) - 2 days later developed diarrhoea Otherwise well at homePlan:Tylosin 300mg SID PO 10 days, then up to TIW as neededRx Hills i/d dry +/- wet, until faeces normal for at least 3 weeksThen consider low protein dietRx further workup if signs of inappetence/weight loss/progressive diarrhoea/vomiting etc - bloods, abdominal US