C10004384 / invoice 20000

06/03/2026 Email from Owner:
Thank you for looking after Odie today and spending the time to run through his health history. It was greatly appreciated.

Apologies again for having to depart in a hurry. I will be back tomorrow for the appetite stimulant, should we have no luck overnight with him.

Kind regards,
Leanne Sutcliffe

06/03/2026 Requested SAH Norwest and SAH Kellyville to send patient history with any available results. kt 


06/03/2026 BIB Leanne, here for second opinion. Entire male.

HISTORY
- Decreased appetite over past week, eating 50-70% of daily intake. Always been very fussy eater. Last proper full meal was monday or tuesday.
- Underweight, trying to gain weight - this has been an ongoing issue
- No vomiting, but has had loose stools last couple of days; does get d+ from time to time and occasional constipation - o sees straining to defecate sometimes.
- History of eating non-food items (twigs, random objects)
- Previously on Protexin, currently has a probiotic in water
- Weight slight reduced at 5.4 kg, weight in December 5.8kg
- Parents' weights: Dad 5 kg, Mom 8 kg
- X-rays showed marked hip laxity bilaterally (Jan 2025)
- lip smacking at home.
- current diet frontier pet (dehydrated raw food), cooked chicken/beef, ziwipeak can, fresh veg. prime 100 rolls beef/chicken. hasnt liked tetra packs in past. O essentially offering anything so Odie will eat.

SAH - Laboratory Results
January 2025 bloodwork
ALT: 79 U/L (mildly increased)
WBC: 21.5 (leukocytosis) Neutrophilia, Lymphocytosis, Monocytosis 

June 2025 bloodwork
ALT: 486 U/L (marked elevation)
Globulin mildly low 24 (25-45)
CRP normal (2.7 mg/L)
ALP, bilirubin, GGT normal

September 2025 bile acids
Fasting bile acids: 1 µmol/L (normal) (0-11)
Post-prandial bile acids: 29 µmol/L (0-21)

EXAM - very BAR.
mm pink, moist, CRT <2s
Ears/eyes nsf - is head shy
Teeth good on quick check
Chest ausc - no murmur heard. no arrhythmias.
Abdo palp - soft and comfy, no pain, no masses. V skinny.
LNs wnl
T 38.7C
Skin/coat good.
Hips - does not want to extend at all, both hips.
BCS 1.5/5
Weight: 5.4 kg

DIAGNOSIS
- Reduced appetite, chronic. tendency for diarrhoea. belching/burping heard by myself and KS during venipuncture.
- GIT disease  (intolerance, inflammation, infectious seem more likely than FB) vs EPI/pancreatic disease vs gastroesophagitis/reflux vs liver disease (microvascular dysplasia / PSS)
- entire male dog can be lean with reduced appetite however I am concerned there is underlying disease process in this patient

PLAN
- Discussed options - further inv with rpt bloods (incl TLI to rule out EPI, odie has not eating this morning so is a fasted sample), abdo u/s, faecal testing. VS referral VS treatment trials e.g. food, cerenia, losec, etc.
- O elected to go ahead with bloods today (Idexx THP, Vetnostics TLI) + check EHW availability for next week.
- Discuss potential use of anti-nausea medication and antacids - o keen to try over weekend. Ok to use mirtazapine if nec over weekend.
- Consider fecal PCR test for infectious diseases
- Possible future tests: cortisol level for Hypoadrenocorticism, check B12, rpt bile acids, liver biopsy if indicated...

06/03/2026 O had to rush out after consult before mirtapazine dispensed. Ready for O to collect along with faecal container if d+ persists.
NH called Leanne to explained mirtazapine ready for pick up. O gave cerenia and losec at 2pm, just now at 75% of breakfast - o pleased and said she may not need appetite stimulant. Rec cont cerenia for at least 48hours after appetite back to normal. Cont losec. 
Please call O with EHW abdo u/s availabilities.

07/03/2026 TLI  31

07/03/2026 Owner brought in faecal sample today - sent for diarrhoea panel.

- patient ate small amount of food yesterday
- seems mildly improved
- owner did observe some 'burps' and lip smacking
- picked up mirtazapine that had been made up yesterday

- Reported blood results mostly NAD - increased ALT - hepatopathy either primary or secondary to pancreatic issues?
- TLi WNL - ruled out EPI
- still waiting for cpL
- owner happy to book in for abdo ultrasound asap
- offered ondansetron but owner declined for now

07/03/2026 booked ultrasound for Thursday 12th March, pre op notes emailed - estimate to be sent on Monday (NH to complete estimate, verbally given range)  ph

07/03/2026 O called and advised got home from Groomer this morning and had a bit of blood in it. Advised to send us the photo and will let the vet know.  ph

07/03/2026 emailed invoice from this morning as the printer was not working
sent preop instructions for ultrasound
estimate made but needs checking by vet  ph | 07/03/2026 TLI  31

07/03/2026 Owner brought in faecal sample today - sent for diarrhoea panel.

- patient ate small amount of food yesterday
- seems mildly improved
- owner did observe some 'burps' and lip smacking
- picked up mirtazapine that had been made up yesterday

- Reported blood results mostly NAD - increased ALT - hepatopathy either primary or secondary to pancreatic issues?
- TLi WNL - ruled out EPI
- still waiting for cpL
- owner happy to book in for abdo ultrasound asap
- offered ondansetron but owner declined for now

07/03/2026 booked ultrasound for Thursday 12th March, pre op notes emailed - estimate to be sent on Monday (NH to complete estimate, verbally given range)  ph

07/03/2026 O called and advised got home from Groomer this morning and had a bit of blood in it. Advised to send us the photo and will let the vet know.  ph

07/03/2026 emailed invoice from this morning as the printer was not working
sent preop instructions for ultrasound
estimate made but needs checking by vet  ph