C10013335 / invoice 10000

Reason: Uti ReoccurenceSubjective:- Urinary tract infection symptoms with straining to urinate and haematuria- Symptoms commenced over weekend, initially spotted urine, now frank haematuria- Frequent urination with small amounts- Generalised pruritus affecting legs, perineal region, and one ear- Scratching under one leg and around vulva- History of recurrent UTIs despite being on CD diet- Previous cranberry supplement provided 6 months UTI-free period, discontinued due to diarrhoea- UTI recurred after discontinuing cranberry supplement- Weight loss from 11.1kg to 10kg- Hind limb weakness preventing stair climbing for 18 months- Will climb front stairs (8 steps) but not descend, avoids internal staircase (12 steps without landing)- No ataxia or foot dragging observedPast Medical History:- Recurrent UTIs since young age- Previous bacterial pyoderma treated with antibiotics (16/02/2026, completed course)- History of ear infections, currently improved- Previous elimination diet trial not performed- Currently on Optimum dry food, previously on CD dry food- Cranberry supplement discontinued due to diarrhoeaObjective:- Physical examination performedMm - pink moist Hr = 140 reg no murmur audible Abdomen - a bit tense  difficult to assess bladder but it is small and no obvious stones notes - Ears appear waxy with narrow canalsPerivulval region is swollen and with hyper pigmentation due to  chronic pruritis/  atopy Assessment:- Urinary tract infection with haematuria- Recurrent UTI history with possible ascending infections secondary to perineal pruritusLaboratory: -  voided Urine sample collected showing significant haematuria and bacteria (mostly rods)Urine - rods +++  on manual exam , lots of blood and WBCs , no crystals Plan:Advised ultrasound of bladder and collect urine but cysto _ O declined. Just wants the antibiotic injection - convenia ( has difficulty with tablets ) Cautioned O about resistance particularly with this antibiotic - advise increase water intake / preferably wet c/d - Broad spectrum antibiotic injection administered today- 1 ml convenia s/c - Discussed urine culture and bladder ultrasound for future episodes to avoid antibiotic resistance- Consider longer term Zenralia therapy for skin condition to prevent possible  ascending UTIs- Continue cranberry supplementation once current infection resolved- Maintain current diet with emphasis on water intake- Monitor hind limb weakness- Follow-up call planned Monday/Tuesday next week to discuss Zenralia trial    Vital Signs    Weight: 10.6;