C10015753 / invoice 10000

Bloods not showing typical signs of pyo, have discussed this and will treat for UTI. Asked o to monitor carefully for signs and advised of the potential risks if pyometra occurs. Did advise o of potential for bacterial resistance given she has had a lot of UTIs in the past - if not resolving then would strongly recc'd cysto sample to send away for C&S also discussed testing for cushings, given the ongoing symptoms and the lover changes on bloods.Ultrasound 5 months ago showed minimal changes in the liver and one adrenal was enlarged - should really follow up with ACTH stim test - o will consider and look at booking in for this once UTI has resolved.     Vital Signs    

Appointment Notes: Son bringing in, suspects UTI, running around dribbling urine everywhere, squatting to pee but urinating small amounts only. Seems distressed and didnt drink much this morning.Hasnt been offered food yet todayno vomiting or diarrhoea prior to this was EDUD wellcollected free catch urine sample:USG 1.022protein 3+ery 1+pH 9sediment: some bacteria- cocci, and few WBCs - not typical of UTI- would recc'd bloods to ensure no other underlying cause, particularly concerned about pyometra, given she is entire. vaginal swab: small amount of bacteria, no discharge or bloodo elected to take bloods - see next consult for results.Lucy is very sensitive to meds, so need to take care with use of these     Vital Signs    Weight: 6.6 (Patient Update);       MMColour: Pink;       Abdomen: Abnormal (tense in abdomen on palpation, is very anxious - unsure if pain response or temperament );       RectalGenetalia: Abnormal (Vulva is normal size, no obvious discharge, but above the vulva is inflammed and skin appears chronically thickened and dry. Taken swab to assess);       Demeanour: BAR;       Hydration: Normal;       Temperature: 39 (is stressed/ anxious);       BodyScore: 5;       CRT: 1-2;