C10011039 / invoice 10000

Reason: AuS With Simmi @12pmAppointment Notes: confirm an admit time with Ownercalled, LVM, sent txt to confirm BEHistory: SDMA 17Creatinine 0.11USG 1.014 --> 1.017 on second sample On biome & apoquel. O noticed that he have big drinks, but not frequentlyAnaesthesia: 0.54ml butorphanol , 0.54ml acp IM sedationBrief summary ultrasound findings (Simmi from Vet Ultrasound Group)Bladder NProstate NMILNs NAdrenals NKidneys NSpleen NLiver NGallbladder NGIT NPancreas NNo ultrasound abnormalities identified to explain this animals presentation. Continue to monitor for any localising abnormalities which may aid in diagnosis. Consider urine culture - given that urine has been repeatedly dilute on assessment I would advise a culture to rule out infection.    Vital Signs    

Client communication: - Jolene (Rudi's owner) - 19/02/2026 - Phone (voicemail message) - Discussed Rudi's recent urine and blood test results have left as voice mail  - N/A - Rudi's urine remains dilute with a suboptimal concentration (specific gravity 1.016, previously 1.014). Blood work shows normal urea and creatinine, but an elevated SDMA level. This is suggestive of early renal insufficiency. Two options were proposed for the next steps. Option 1 is to proceed with a full abdominal ultrasound to assess the size and shape of the kidneys for chronic changes, and also to evaluate the gut lining and other abdominal organs. The estimated cost for this procedure is $650 and it requires booking with a visiting ultrasonographer. It was noted that this is not an emergency and there is no immediate need to start medication or change his diet. Option 2 is to continue monitoring. This would involve a revisit in one month to rerun the SDMA and creatinine, and to recheck a urine sample. Strong advice was given to ensure Rudi remains well-hydrated and to avoid dehydration, particularly from any relapse of diarrhoea or vomiting. If a relapse occurs, more aggressive treatment including fluid therapy may be required. - The client was advised to either contact the clinic to book the abdominal ultrasound or to book a revisit appointment in one month for follow-up blood and urine tests. - N/AConsultation:Consent has been given by the client to proceed with this treatment  -  Yes/No    Vital Signs