C10010939 / invoice 10000

History: Recheck urinalysis with culture, 2 weeks after restarting Nitrofurantoin for relapsed MR E.coli UTI See previous histories for details Thinkts Abs Not eating Diarrhoea last few daysDry retching again Last time better a day or twoHad 18 days of Abs No UTI signs, Stopp licking her bits Current medications: 1) Diet: Prime100 Kangaroo 2) Nitrofurantoin 5mg/kg tid (2 x 100mg cap + 1 x 50mg cap) x 4 weeks Problem List: 1) Lameness and reluctance to move, reported ~22/8/23, marked multiple joint effusion 12/9/23, joint aspirates --> neutrophilic inflammation, negative culture. 2) Lethargy and hyporexia reported 12/9/23 3) Pyrexia 12/9/23 4) Lymphadenomegaly on CT (some abdominal, peripheral and thoracic) 12/9/23; aspirate of left MILN 13/9/23, cytology -> reactive LN 5) Right lung ventral alveolar pattern on CT 12/9/23, consistent with aspiration pneumonia, localised purulent exudate visualised on bronchoscopy, BAL -> mixed inflammation, predominantly with neutrophils and macrophages; heavy growth of Stenotrophomonas maltophilia and Enterococcus faecium 6) Multiple pulmonary lesions, consistent with thromboembolic disease on CT 12/9/23 7) Multiple pulmonary nodules, ddx granuloma vs neoplasia on CT 12/9/23 8) Vomiting/regurgitation reported 13/9/23. Chronic hx of regurgitation after drinking, recent increase in frequency 9) Mild cutaneous signs 19/9/23 - mild lip oedema and erythema, papules on ear and axilla region, single ruptured vesicle left medial pinna, some mild depigmentation around oral mucocutaneous junction and a single erosion right upper lip 10) Haematuria, pollakiura and stranguria 10/10/23, UA and culture -> haematuria, proteinuria, no pyuria and negative culture, suspect renal haemorrhage ddx renal infarct, glomerulonephropathy; gross haematuria and urinary tract signs resolved, UPC 17/10/23 = 0.6 11) Hyporexia and diarrhoea ~ 5 days reported 19/10/23 12) Anaemia PCV 33% 16/10/23, 35% 19/10/23 13) Septic peritonitis (11/11/23) secondary to gastric ulceration; multiresistant organisms (E coli, pseudomonas, enterococcus) cultured. 14) Recurring lameness and generalised joint effusion (08/12/2023) - Ddx IMPA relapse 15) Skin pustules on mid-line dorsum between scapula (22/01/2024) - Cytology = cocci bacteria - Rx with Chlorhex 0.05% and Amoxyclav Assessment: Pending urinalysis with culturePlan: 1) Vetnostics urinalysis with cultureTreatment: See SmartFlow for full treatment records Current medications: 1) Diet: Prime100 Kangaroo 2) Nitrofurantoin 5mg/kg tid (2 x 100mg cap + 1 x 50mg cap) x 4 weeks    Vital Signs