C10003604 / invoice 10000

Reason: Recheck BG

History:
Started Denamarin on 28/2. Not easy with dosing.
28/2: Vomited yellow froth 20mins post-denamarin
2/3: Same episode 40mins post-denamarin
SP checked with ADM rep Dr Benjamin re. the above. Adv stopping Denamarin for 2 days, restart if no further v+. Can consider giving silybin only. SAMe has been reported with nausea and vomiting on some rare cases.

Fed 8.40am but has only eaten about 80%.

Assessment:
BG 4 hour post meal = 4.8mmol/L normal

Plan:
1) Due for Advocate tomorrow. Ok to give. Has been on it before, no prev reaction to Advocate.
2) Await abdo ultrasound exam - booked 19/3/2026
3) If v+ again after giving Denamarin, will switch to milk thistle supp only

Idexx Canine Screening Profile with TT4 results:
L MCHC 325 (326 - 392 g/L)
H WBC 19.6 (4.9 - 17.6 x10^9/L)
H Neutrophils (16.3 2.9 - 12.7 x10^9/L)
L Glucose (Fluoride oxalate) 2.5 (3.3 - 6.8 mmol/L)
L Creatinine 20 (50 - 130 µmol/L)
H ALT 434 (16 - 90 U/L)
H AST 254 (18 - 80 U/L)
L Amylase 261 (333 - 1,500 U/L)
H Creatine Kinase 731 (73 - 510 U/L)
H C-Reactive Protein (CRP) 25.9 (0.0 - 10.0 mg/L)

AC to Catherine:
"Please find attached a copy of Cookie's comprehensive blood test result for your record. The result is consistent with what we found at our clinic. It confirmed elevation of his liver parameter ALT, as well as AST which we didn't have with our inhouse test. We also found his inflammatory marker called C-reactive protein and white blood cell called neutrophils were also increased. His fasting blood sugar was definitely lower than expected but we can check him again when not fasted to see if this is consistent.

Going forward, we can consider using a liver protective supplement for 1 month (eg. Denamarin or Milk Thistle) and then recheck his blood again. Otherwise, we can perform an abdominal ultrasound to investigate his liver further either now or wait until after the next blood test if his problem persists."

27/2 SP s to Catherine
Will p/u Denamarin today. Adv to give 1hr before or 3hrs after meal.
Hepatic diet? To be decided post-AUS. Given a can of RC Hepatic wet to try. Current diet is Prime100 air dried duck.
Recheck BG anytime but ideally 4hrs post-meal.
To book in AUS with ImagingVets for 19/3. Req submitted.

Reason: Castration - Aborted

Presented by Catherine.
On Pro-Kolin when needed. 2 episodes of unformed stool in Jan, resolved after Pro-Kolin.
V+ of froth few times a month
Picky eater.
Consented to PAP, temp teeth extractions and dental rads. MINIMUM CLIPPING pls :)

Pre-op vitals: HR/PR 120, RR 40, MM pink, CRT 1-2s. Calm dog.
Temp teeth: upper incisors x4, canines x4, pre-molars x3, so at least 11.

Blood collected from R jug for IH PAP:
GLU 3.28 (4.11 - 7.95) LOW - from fasting?
CREA 20 (44 - 159) LOW
ALT 430 (10 - 125) HIGH
PCV 46%

SP s to O and advised aborting sx for today. Discussed about comprehensive bloods +/- AUS.

Offered water and treats to Cookie but not eating/drinking in clinic.
Nails clipped.

Plan:
1) Withhold sx, pending bloods results.
2) Protexin paste
3) Feed and water when home