C10005965 / invoice 10000

Appointment Reason: 1.1 CONSULT 1, Appointment Notes: Owners daughter bringing her in. Feel free to call Matt if daughter is unsure on treatment plan MLPaws App Details:Booking Type: Consultation (Up to 2 concerns)Booking Notes: Continued kidney issues, constant blood in urine. Suspect UTI, would like tests and antibioticsOwner Are you a Pet Club Member?: NoOwner Are you interested in learning more about our Pet Club?: NoPet Insured: Yes.Vet: Dr Andrew Neutze, BVSc MVetSci  REASON FOR VISIT    Presenting Concerns:-   Persistent haematuria.-   Unusual behaviour, including restlessness and increased vocalisation.  Other concerns:-   Wobbly hind legs and secluding herself.-   Historical Conditions: Jersey has a history of kidney issues and has been seen for haematuria on two previous occasions, 9 and 12 months ago. Previous urine cultures on both occasions were negative for bacterial infection. A heart murmur has been previously noted, graded at 2/6 and then 3/6 nine months ago.-   EDDU: Jersey is on a kidney diet. The owner reports a decreased appetite over the last week. She is passing small volumes of urine frequently. She prefers to urinate outside and will only use a litter tray if kept indoors.-   Mobility: The owner reports that Jersey has looked very wobbly on her hind legs for the last 1-2 weeks.-   Lifestyle Risk Factors: Jersey is a 15-year-old cat who lives with one other cat. The household recently moved, which may be a source of anxiety. She has some outdoor access.-   Additional Information: The owner reports that Jersey has been more vocal than usual, crying and going from person to person. She has also been secluding herself in cupboards or on shelves. Her parents were away last weekend, which may have caused some stress.-   Current Medications: Currently on a kidney diet.Vaccination Status:PHYSICAL EXAMWeight: 3.63 kg. T: 37.1, HR: 208, RR: 32bpm normal effort, MM: pink/moist. CRT < 2sec., BCS: 3/9  Mentation: Bright, alert, and responsive  -   EYES: No abnormalities detected-   EARS: No abnormalities detected-   NOSE: No abnormalities detected-   ORAL / DENTAL: Dental score: 2/4-   HEART SOUNDS: Grade 4/6 heart murmur noted.-   RESPIRATORY: Normal bronchovesicular sounds bilaterally.-   ABDOMINAL: Faeces are palpable in the colon. The bladder is moderately full. No organomegaly or mass effects. No pain on palpation.-   EXTERNAL LN: No abnormalities detected-   UROGENITAL: No abnormalities detected-   RECTAL: Not performed.-   SKIN AND COAT: No abnormalities detected. No lumps noted.-   MUSCULOSKELETAL AND GAIT:-   NEUROLOGIC: Normal mentation.  DIAGNOSTICS  A urine sample was able to be collected.ASSESSMENTChronic Kidney Disease – Previously diagnosed. There is concern for progression of the disease, given the significant weight loss and persistent haematuria.  Persistent Haematuria – DDx: Upper urinary tract disease (e.g., urolith, neoplasia, inflammatory disease), progression of chronic kidney disease, idiopathic renal haematuria. Two previous urine cultures were negative for bacterial growth, making an ongoing lower urinary tract infection less likely.  Significant Weight Loss – A loss of 0.5 kg has been noted over the last 9 months. DDx: Progression of chronic kidney disease, protein-losing nephropathy, cardiac cachexia, hyperthyroidism, occult neoplasia.  Heart Murmur (Grade 4/6) – This represents a significant increase from a previously documented grade 2-3/6 murmur. DDx: Progressive primary cardiac disease (e.g., cardiomyopathy), secondary cardiac changes. This may be contributing to clinical signs of weakness and weight loss.  Hindlimb Ataxia and Weakness – As reported by the owner. DDx: Systemic weakness secondary to cardiac or renal disease, degenerative joint disease, primary neurological disease, hypertension.  Behavioural Changes (vocalisation, restlessness, seclusion) – DDx: Pain or discomfort (urinary, cardiac), anxiety secondary to a recent house move, cognitive dysfunction, hypertension.PLANDiagnostics pending:-   A comprehensive blood screen was recommended to evaluate organ function, thyroid levels, electrolytes, and haematology.-   A urinalysis and a urine protein to creatinine ratio were recommended to further stage the kidney disease and investigate for protein loss.-   Further diagnostics were discussed, including an abdominal ultrasound to investigate the upper urinary tract for structural causes of haematuria, and an echocardiogram to assess the structure and function of the heart.  Medications/Treatments:-   Jersey will be admitted for the day for blood and urine sample collection.  Additional Discussion:-   A detailed discussion was had regarding the diagnostic plan and associated costs. The owner was advised that the blood and urine tests for today would cost approximately $700. An estimate for the full diagnostic workup, including targeted ultrasound ballpark starting at 1700 but may be more. A formal estimate will be emailed to the owner.-   The owner has pet insurance and the possibility of a no-gap claim was discussed.-   The owner provided verbal consent to proceed with the blood and urine tests today. They will consider the further diagnostics after reviewing the formal estimate.-   The timeline for diagnostics was discussed: blood and urine tests today, abdominal ultrasound within the next few days, and the echocardiogram may take a couple of weeks to schedule with a specialist.-   Results will be communicated once available.This document was generated with the assistance of CoVet AI to support accurate and efficient documentation.Communication:Left message asking O to call back re results of bloods at 2.20pm.    Vital Signs    

History:Has been having haematuria the whole time since last seen. Acting abnormally and has been pacing and crying out recently. Appetite: not seeming to eat well since have been taking care of but only recently as daughter taking care of. unsure re type of urination lately. Vocalisation that different lately. No vomiting or diarrrhoea recently. Examination:1. Lost weight2. ongoing haematuria3. No abdominal pain4. perhaps early constipaton5. Heart murmur louder than prev detected. Plan:1. Urinalysis + UPC and culture if indicated?2. Bloods incl phos and lytes3. urinary tract US. 4. echo5. Blood pressureO ok with initial plan. Will await official estimate re ultrasounds. BP inhouse doppler:Systolic 118mmHg on L cephalic size 2 cuff.    Vital Signs    Weight: 3.63;