C10016494 / invoice 10000

recheck bloods renal failure
Person (Justin) 
Insurance (yes - gap only pls)
Reminders ()
Preventatives (utd)

PRESENTING CONCERN(S):
Recheck consultation for previously diagnosed renal disease.

HISTORY:
Reuben presented for a recheck of his renal disease. The owner reports a significant improvement in his overall condition since a dietary change was implemented for his concurrent renal disease and pancreatitis.
The owner reports Reuben has increased energy, is no longer groaning when moving, and is able to jump into the car unassisted. His demeanour is much brighter, and he has a renewed interest in activities he has not engaged in since he was a puppy. His coat quality is also reported to have improved.
Gastrointestinal signs have resolved, with stools now being well-formed and of a normal tan colour, whereas previously they were black. His polydipsia has resolved, and the owner notes he is now drinking less water than previously.
New concerns raised by the owner include an increase in sneezing and a new, intermittent dry cough, which is more noticeable in the early mornings.

Diet: Fed two-thirds of a can of wet renal food and three-quarters to a full cup of Royal Canin gastrointestinal low-fat dry food per day, split into two meals.
Current meds: nil reported.
Prophylaxis: not discussed.
Pre-existing conditions: Renal disease and pancreatitis. Multiple small, warty-type cutaneous lumps are present, which have been previously assessed by other veterinarians and deemed benign.
Access to toxins e.g. Rodenticide: nil known.

EXAMINATION:
Body Condition Score: 5/9
Pain Scale (0-4): 0
Hydration status (%): euhydrated
Cardiovascular: HR 90. cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous
Respiratory: RR panting, thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge
Musculoskeletal: ambulating normally x4, no palpable neck, spine, limb or joint pain
Gastrointestinal:
- Oral: NSF, no mouth pain, dental score: 2/4, worn teeth
- Abdominal: comfortable on palpation, no obvious foreign body or mass effect, no significant distension
- Rectal: not performed
Urinary: NSF
Reproductive (incl ext. genitalia): NSF
Integument/Ears: several small nodular lesions - previously examined
Lymph Nodes: Peripheral lymph nodes WNL on palpation
Eyes: NSF

PROBLEM LIST:
- Azotaemia (historical)
- Pancreatitis (historical)
- Marked clinical improvement on therapeutic diet
- New onset cough and sneeze

DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:
- Renal dysfunction.
- Pancreatitis.
- Chronic enteropathy.
- Other.

DIAGNOSTIC/MANAGEMENT PLAN:
The plan is to repeat blood tests to re-evaluate renal parameters. Further diagnostics discussed include a urinalysis (first morning sample) to assess urine concentrating ability and check for proteinuria, and blood pressure measurement. Management will be guided by clinical response and diagnostic results. If Reuben remains clinically well, the plan is to continue with the current diet.

DIAGNOSTICS:
In-house biochemistry panel to re-evaluate renal function.

ASSESSMENT:
Reuben is a dog with historical renal disease and pancreatitis who has shown marked clinical improvement following a dietary change to a prescription renal and low-fat gastrointestinal diet. His energy levels, mobility, and stool quality have all significantly improved. The owner reports new, mild respiratory signs (coughing and sneezing). The plan is to re-evaluate his renal function via blood testing and continue current management, as the primary goal is to treat the patient's clinical state rather than focusing solely on blood work.

TREATMENT:
- None indicated at this time. 

PLAN:
Continuation of the current diet is recommended.
The owner was advised to monitor the frequency and timing of the coughing.
A urine sample may be requested in the future to perform a urinalysis.

CLIENT COMMUNICATION:
A detailed discussion was had with the owner regarding Reuben's significant clinical improvement. The importance of the prescription diet in managing renal disease and prolonging quality of life was explained. The plan to repeat blood tests and potentially perform a urinalysis and blood pressure check in the future was outlined. The approach of prioritising the patient's clinical well-being over the numbers on the blood results was emphasised. The non-specific nature of coughing was discussed.