C10009331 / invoice 10000

REASON: RecheckHISTORY:See previous HxO report going well at home, no urinary signsEating wellMaybe equivocal polydipsia again, but gave her a bowl of water yesterday and wasn't drink a lot Collected urine at homeIn today for repeat POCUS to check for urolithiasisAlso needs AG expressedEXAMINATIONBAR BCS 6/9Hooded vulva - no dermatititisRectal - mildly impacted AG, expressed, normal contentsPOCUS of UB - there is a solitary hyperechoic, strongly shadowing urolith present within the urinary bladder, measuring 3mm in length. The cranioventral urinary bladder wall is subjectively thickened. LABORATORY:Free catch urine USG 1.044See attached UA and Sedivue - unremarkableASSESSMENT:Small solitary urinary bladder urolith, hooded vulva, history of recurrent UTIs, subjective cranioventral thickening of the urinary bladder on ultrasound. Suspect the urinary bladder urolith is likely struvite given signalment (middle aged female) and history of UTIs and hooded vulva. But not definitive without testing. Today, no clinical signs of UTI at home or evidence on urinalysis. However, does have a urolith and cranioventral thickening of the UB wall (which may be an acute or chronic change). Monitor very closely for signs of UTIs - may be indicated to continue a long course of abx until the urolith as resolved, but also given the lack of CS after weeks off the abx this may not be needed or prudent use of abx. Is overweight. History of GIT disease and well controlled on current hypoallergenic diet, however given the strong evidence of a urinary bladder urolith STILL being present and history of UTIs and hooded vulva predisposing her to ongoing UTIs, there is strong indication to transition to C/D diet. Advised best to add in the C/D + metabolic as weight loss will possibly help with the hooded vulva. PLAN:Slow transition to Hills C/D and metabolic diet Update AH if any concerns but clinically wellRecheck if any urinary signs, notable pu/pd, or significant GI signsIf going well, recheck + POCUS in 1 month to check urolith Continue CystoproFrequent cleaning of vulva with dilute betadine and pat dryRepeat blood work and urinalysis in 2-3m to monitor renal function    Vital Signs