C10005245 / invoice 10000

Reason: UTI?Appointment Notes: q $268+ Cx after hrs fee, if after this time then $321+, JCS.History: This morning straining regularly to urinate , dropped in a urine sample - see previous entry - evidence fr bacterial UTI, recommended consult and owner elected to come back down for A/H appointment Yesterday went to the lake (usual activity) and then had bath at pet barn towel dryAlso had a birthday celebration yesterday as birthday is this week .  Has had one occurrence when about 5 mnths old (would have been seen at BRVC) of a UTI, but no issues since Has been good since last visit and paws seem to be healing okIs on pets park skin and coat powder to help with skin Has had Hx of otitis, hot spot , has been on apoquel at one stage Does not generally scratch much Cleans ears regularly with a finger wipe which she tolerates - has not historically been good with ears. Clinical Signs:BAR, nice dog but nervy, intermittently jumpy with exam. Mms pink refill 1sec, teeth good, chest ausc ok, abdo palpation ok , temp 38.6, vulva is quite hooded, the perivulval fold is deep and hair stained brown - CA prep- no increased malassezia evident , very slight redness of skin in fold, no discharge, no discharge from vulva. Ears- subtly red (has not been irritated) swab from canal small amt discharge - on cytology no inflam cells, occ malassezia, mainly squames, rest of skin I can see looks ok Assessment: Bacterial UTI (see UA results on previous entry) Clinical signs of pollakiuria and stranguria also consistent. Hooded vulva and probable underlying atopy, likley predisposing factors for ascending infectionDiscuss other possibilities such as bladder stones, lesions etc Ears presently ok but monitor for any increased irritation or discharge Treatment: Has hexacon wash at home, use to clean perivulval fold daily and dry Amoxyclav 500mg BID for 5 days, then when stopped drop in repeat UA See sooner if signs not resolving which expect they should quickly if on the right trackDiscuss if recurrent may be further steps eg culture, possible increased management for skin, imaging, consider vulvoplasty etc    Vital Signs    Weight: 34.3;       

Reason: Straining Multiple TimesAppointment Notes: only started this morning. O bringing in urine sample for us to test. DW. MM dropped in sample, said dog had done 4x wees in an hour and had a little whimper. They did go to the beach yesterday, she didnt towel dry them afterwards as usual but this is the only abnormal thing lately. JCS. Urinalysis:Performed by: JCSUrine Collected: Free catchLEU=2+NIT=negpH=8PRO =2+GLU=normKET=negUBG=normBIL=negERY=4+Hb=negUSG=1.032Urine Appearance: pale yellow, slightly murky. Sediment Appearance: big white sediment, stained. JCS.KC: highly cellular - large numbers of neutrophils++, large numbers of chaining bacteria, short rodsAssessment: Consistent with bacterial UTI Honey needs to have a consultation - JCS call to offer coming down for after hours time today (now 11:15am) or early appointment Monday . O elect to come now    Vital Signs