C10018595 / invoice 10000

    Vital Signs    

Reason: COMING UP NOWAppointment Notes: Wouldn't move properly. Wee'd himself.Combined effort LW/ LD/ ASSubjective and history: Heard a cry, laying flat and wet him. Seemed flat and weak and urinated insideHas been wellMouth open and tongue out.Lately urinating fine, UTD with tick preventionIndoor cat, occasionally taken to outdoor enclosure but not today.Comms LD with owner later in day- Patricia added Milo appeared non-responsive and collapsed on bed. Then was open mouth breathing. Urinated. No coughing. Sometimes sneezing. Maybe had one similar episode mths ago. Has had previous episodes of urinary blockage. Objective: Weak PantingDifficult to auscultate heartHR low -70Mm pink.SPO2 98% on presentation. BP 172/127, 113/90 (96), 100/63 (75). Hospitalisation: 1Pm: 0.2mg/kg butorphanol IM @ 1pm. Mild sedation. Did not tolerate flow-by oxygen. Placed in cage to settle. 1:30pm: HR 120, no longer panting, RE 0/3. Can be picked up and patted, but too fractious for any more handling. Gave gaba 100mg PO @ 1:39pm. 2pm: Still too wriggly/ hissing for catheter placement. HR 120. 0.5mls alfaxan IM @ 2pm. Great sedation for catheter/ tests. Flow-by mask oxygen. 3pm HR 160. RE/RE stable 32-36 re 0/3 rest of afternoon. No further panting. IV hartmanns @ 13mls/hr from 4pm.Noted to be a little wobbly from 4pm- most likely just gaba/sedatives today- montior. Diagnostics: Ultrasound: AS1 - TFAST No pericardial effusion. Caudally to the apex of the heart is a band of hyperechoic reactive tissue which measures up to 11.9mm across with slips of free fluid at the pleural space (<2mm) Cranially to the base of the heart are multiple prominant hypoechoic lymph nodes which measure up to 13.3mm with hyperechoic surrounds. La/Ao = 13.8/7.8 = 1.77LVIDD = 12.4mm The right atrium is subjectively enlargedAFAST- no ff. Gb 1.3mm wall some sludge present no halo, bladder small with small amount speckled sediment. Thoracic xrays: left middle lung field pleural fissure line, air bronchogram cranial chest lateral view, thoracic oesophagus visible- possibly dt sedation. Biochem: urea 15.9mmol/l, creat 181umol/l ALT 225U/L CBC- HCT 26.8%, PLT 59K/ULCRP- <1 okProbnp- negative.  Assessment: Collapse episode- Anaphylaxis, neuro vs syncopal less likely. BradycardiaThoracic lung changes - infection less likely, cancer. Azotaemia- mild azotaemia- prerenal, renal, post. Elevated ALT- hepatopathy, anaphylaxis. Nonregen anaemia. Possibly sedation related. Plan: Transfer to SASH overnight. Give dinner then fast overnight (no known allergies) for possible CT tomorrow. Consult with internal medicine 12noon. Monitor RR/RE q 2 hours overnight. POCUS as needed. IVF maintenance overnight. Have sent xrays/ ultrasound to sash email.Have not collected urine today. Comms; --- 11/03/2026 16:13:42 LD: Spoke to both owners on phone. Relayed HR has increased slightly. Stable. No more panting. Xrays/ ultrasound have showed something unusual in chest. Could be cancer. Recommend referral to specialist for more workup. Recommend transfer sash overnight for monitoring in case has any further panting episodes tonight. Cannot give exact estimate but we will transfer. Someone at sash will give formal estimate around 7ish. Rough estimate could be $1K tonight then specialist appt. 12noon tomorrow. If they recommend CT/ other tests could be thousands. They are both keen for specialist input. --- 11/03/2026 17:25:26 LD: spoke to steph leeder with plan for evening. Transfer tonight for overnight care and monitoring then possible full body CT tomorrow. 7:20pm: spoke with both owners. Transfer to sash. Stable this afternoon. No longer panting. Has been on intravenous fluids maintenance rates. Maybe had another episode years ago. Explained spoke with medicine specialist today. She thinks the episode is unusual. Could be something more going on in head. Will most likely recommend full body CT after complete review of entire case/ pending how he goes overnight. Cannot give formal estimate. If tomorrow upon speaking with medicine specialist and getting estimate if owner's do not want to go ahead with testing recommended by specialist can be transferred back here/do not hesitate to contact us. Owners seemed keen for specialist review and further testing. Relayed Dr. Steph leeder is really good and he will be in good hands to figure out what is going on with him. He has been transferred there tonight. Ball park ~1K but someone will call shortly with estimate for tonight. I foresee the emergency vets will keep him on fluids/ check his RR/ RE throughout night and may want to do some fast ultrasound scans for fluids during night if his breathing is concerning. The owner has insurance. Ok for us to put through gap. Actually did not relay the final bill to them.    Vital Signs    

Reason: AHCAppointment Notes: Special payment terms exist, Overdue remindersSubjective and History: Routine vaccination.Has not defecated for the last 2d. No known hx of constipation. Diet = Felix wet food + a little kibble + water added. No change in appetite. Prev: due. Had bravecto 3mo. Indoor only. Small amount of supervised outdoor access. One vomit yesterday. Good appetite. Slightly less active. Urinating normally. Hx of FLUTD. Physical Exam:Wriggly & hissing. A little difficult to examine today. HR 180 no HM or arrhythmia ausc. Lungs wnls.MM pink/moist, CRT <2 s. LNs wnls.Dental: moderate calculus on premolars & molars. Abdo soft, non-painful.Skin/ears wnls.Assessment:Clinically well.OK to proceed w/ vaccination.Treatment:F3 SC.Bravecto topical (billed on Milo’s file).Plan:Rec dental S&P.Rec gaba 100mg PO 2hrs pre-admit & gaba prior to future consults    Vital Signs    Weight: 5.4;