C10018162 / invoice 10000

Appointment Notes: Blood Glucose CurveAdmit: SYHBAR at home. O has noticed she drinks more often and has an ongoing urinary issue. 13 days ago, started a course of medications for UTI, finished the course of antibiotics and analgesia, still noticing blood-tinged urine and inappropriate urination/incontinence inside of the house. O happy to run urinalysis today.Did not eat this morning even when O offered a variety of yummy food. Discussed that she used to be a very good eater but since she is older has been more of a grazer, some days eats well, others does not eat.Gave 0.17ml Caninsulin SC at 8:30am even though she did not eat. Discussed this may affect the curve and we may need to repeat curve another day.Case Vet: nil TX Vet: EHB TX Nurse: SYHTime: 12:30Subjective: BAR, happy girl since admit, rests in cage but hops up and wags tail when people come near. Trots around outside. Well behaved for handling.Objective: Weight:HR: 180RR: 104, pantingTemp: n/tMM colour: pink, slightly tackyCRT: 1secPain Score: 1/24Pain Assessment >> urinates frequently. Does not react to abdomen palpation. Comfortable when sitting in cage.____________________________________________Time: 13:45ECG: BeeCardia, recored 4 minutes, wriggly girl, standing in cage. ## asssessed: ____________________________________________Feeding Plan >> Did not eat this morning at home. Offered chicken 20g at 11:00, ate all.Urine & faeces >> Frequent urination and tinged with blood. For the first couple of hours she urinated on her hourly walk and a few times in her cage, puppy pads changed frequently, urinations did slow down early afternoon, only small urinations on walks. No faeces seen.Treatment: Caninsulin (40IU) 0.17ml SC at 08:30Laboratory:Blood Glucose09:30 - 6.7mmol/L (Pet Tracker) + 5.6mmol/L (Freestyle)10:45 - 2.6mmol/L (Pet Tracker) + 2.2mmol/L (Freestyle)11:45 - 2.3mmol/L (Pet Tracker) + 1.7mmol/L (Freestyle)12:45 - 2.1mmol/L (Pet Tracker) + 1.5mmol/L (Freestyle)13:45 - 2.1mmol/L (Pet Tracker) + 1.7mmol/L (Freestyle)14:45 - 2.1mmol/L (Pet Tracker) + 1.5mmol/L (Freestyle)Plan:Blood Glucose CurveUrinalysis +/- further workupDischarge at 19:20Reason: UrinalysisNurse:Time Received:Entered in Vets Column to contact owner:Laboratory: How was the sample collected:Collec free catch Color OrangeClar Very CloudySG 1.028pH 6.0LEU negPRO 30GLU negKET negUBG normBIL negBLD 250WBC 10 /HPFRBC 50 /HPFBACr * Suspect presenceBACc * None detectedsqEPI None detectednsEPI 3 - 5 /HPFHYA None detectednhCST None detectedCRY None detectedCaOxDi 1 - 5 /HPFSTR None detectedBIURAT None detectedBILI None detectedWet prep (if Sedivue images crowded): +++ rbcs, + epithelial cellsDiff Quik smear: no bacterial visualised, occasional macrophage, large number of irregular cells of various sizes, suspect transitional cellsVet checked by: CGPDiscussion with owner:Spoke to O, advised unusual cells in sample. Discussed bladder u/s, if scan unremarkable recommend cysto sample for C&S. O confused why abnormalities weren't detected last time, discussed last sample was just a swab of vulva, not a urine sample, may have had infection masking signs. Usually, UTIs cause insulin resistance which is not what we are seeing with Bubbles. O understanding, just wants explanations. Plan: Proceed with bladder ultrasound Ultrasound:Bladder: large bladder mass filling most of the bladder lumen with irregular margins and a blood supply visible on doppler. Size: 33.6x17.4mmLeft kidney: NAD, size: 48.9x28.2mmRight kidney: NAD, size: 51.8x27.6mmAssessment: Bladder mass - likely a TCC vs other malignant or benign mass Other studies have indicated that approximately 50% of affected dogs have distant metastasis at time of death.3,4 Common sites of metastasis include peripheral lymph nodes and lungsWith no therapy, most dogs are euthanized within 2-4 months because of progression of lower urinary signs Metastasis may eventually occur, even when local tumor and urinary obstruction are treated successfully: Chemotherapy alone typically provides MST of 9-12 months.    Vital Signs