C10004897 / invoice 10000

09/03/2026 Presented for lytes recheck. 


Drinking normal amount for her. No change with urinating inside when given stilboestrol, so O discontinued. 
Appetite not great, eating every day but minimal enthusiasm and has to be encouraged. Doesnt seem improved when given a higher dose of cortisone. 
No V+ or D+ in past few weeks. 
Dementia is getting very bad, very confused at times and seems lethargic, forgets she's eating etc. O hasnt tried the supplement Petz Park Brain support but is interested - gave details again in consult. 

Accidentally ran a CBC and T4 when just needed lytes, no charge to client. 
Slightly high T4 detected incidentally. 
PCV: 37%
Normal CBC. 
Lytes wnl. 

Unsure if thyroid may be enlarged when palpated neck. 
Ultrasounded neck to confirm, thyroid appeared normal, no obvious mass detected.

IDEXX medical specialist - unlikely to be significant, as was only just outside the reference range - likely to be just a variation of normal for Marley. Can get thyroid autoantibodies that cause a high T4 results, but would only investigate for this if has clinical signs of hypoT4. Otherwise could monitor for clinical signs developing and test again if occurs, or could retest in 3 months and see if there is any progression of the hyperT4 result.

ASSESSMENT: lytes wnl, zycortal dose not too high. 
T4 abnormality unlikely to be significant. 

PLAN: Lytes at next zycortal and determine if needs different zycortal dose. 
KC to look into dementia treatment options compatible with all current medications.