C10018655 / invoice 20000

Reason: Was Asked To Return For Urine Test    Vital Signs    

Reason: Condition Is WorseAppointment Notes: kr 4.9kHISTORY:Charlie presented 10 days ago to Dr. Mieke with blood in urine that was clotted and increased urination frequency. Blood in urine has resolved, however urination frequency has increased further. Now drinking more frequently. Experiencing intermittent straining and occasional whining. Lost appetite today - did not finish breakfast which is unusual. Showing lethargy and decreased energy levels. Usually urinates 2-3 times daily, but yesterday urinated 5 times in single evening.Pre-existing conditions: heart murmurExamination Findings:Body Condition Score: 5/9 Pain Scale (0-4): 0 Hydration status (%): hydration clinically adequateCardiovascular: 152HR, right sided grade 2/6 heart murmur present, otherwise cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: 20RR, thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: pink mm, CRT 1 sec - Abdominal: no detectable pain on abdominal palpation- Rectal: right side of prostate feels more enlarged in comparison to the left Urinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: BAR Temp: 39.0ASSESSMENT:Charlie presented with ongoing urinary frequency and polydipsia following previous episode of haematuria. Physical examination reveals heart murmur with otherwise unremarkable findings. Given increased drinking and urination, further investigation required to assess kidney function and identify potential underlying pathology.Laboratory: Renal panel: SDMA 9 µg/dL 0 - 14 	CREA 73 µmol/L 44 - 159 		UREA 3.4 mmol/L 2.5 - 9.6 	BUN/CREA 13 PHOS 1.22 mmol/L 0.81 - 2.20 ALB 32 g/L 22 - 39Radiometer: Na 152 HIGHK 4.8 CL 116CA 1.35 LAC 5.0 HIGH GLU 6.7 HIGH PH 7.220 LOWPCO2 52.4 HIGH SBE -6.3 LOW HCO3 21.4 Anion Gap 20.0 PO2 29.2 LOWPCO2 52.4 HIGH Ultrasound report:Attempted to do it while concious, Charlie urinated while attempting to restrain AFAST: bladder small with no obvious lesion present PLAN:Hospitalise for a short period of time to allow bladder to fill and collect urine via cystocentesis for vetnostic C/S and POCUS assessment of bladder Treatment: Trazodone 25mg PO given CLIENT COMMUNICATION:Discussed investigation plan including blood work, urine testing and ultrasound examination. Explained difference between in-house and specialist ultrasound options. Specialist ultrasound at sister clinic approximately $1500, call-out fee to current clinic approximately $2500. Laboratory urine analysis more accurate than in-house microscopic examination.--- 11/03/2026 16:50:13 AWC:STO and advise the blood results are within normal limits. Attempted to conduct AFAST but charlie urinated prior to the AFAST so difficult to assess the bladder when the bladder is so small. Advise can hospitalise charlie for a short bit to allow his bladder to fill and give mild sedation to allow us to better assess the bladder. Advise an additional $205 for 6 hour hospital stay. Owner consented to the hospital stay    Vital Signs    Weight: 4.9;       

Reason: UTI?History: Stranguria with bloody clots in urine. Episodes of straining to urinate with no urine production alternating with episodes producing yellow urine containing blood clots. Pollakiuria. History began this morning. No similar issues in the one year of ownership.- Preexisting heart murmur, not on cardiac medications- Previous cruciate ligament tear- Up to date with vaccinationsPossible exposure to rodents around the house.Otherwise BAR, no lethargy, PU/PD, vomting, diarrhoea, coughing or sneezing Physical Exam: - Demeanor: BAR, fas 2/4- Temperature: 38.4 degrees- Heart rate: 112 beats per minute, strong and synchronous pulses- Pulses: strong and synchronous- Respiratory rate: 20 breaths per minute, normal- Respiratory effort: WNL- Mucous membranes: pink with capillary refill time less than 2 seconds- Ambulatory: WNL- Heart murmur: present (preexisting)Body weight: 5 kilograms- Urine sample collected showing blood clots- urinated on consult floor No other evidence of clinical bleeding including petechaie Assessment: Problem list:1. STranguria2. Pollakiuria 3. Blood clots in urine, rest of urine no haematuria Ddx: UTI, crystalluria, sterile cystitis, coagulopathy Client Communication: Option recommended: urine dip stick, sedivue, USG, wet prep, dry prep, chem 10 + SDMA, CBC, pt and aPTT- estimate $1300Also recommended POCUS: O declined for today Concerned re clots- if cost an issue can do urinalysis as above and blood smear O aware next step specialist US VS GP POCUS to look at bladder and kidneys, r/o neoplasia ect Diagnostics: CBC: mild leukogram, likely inflammatory, mild reticulocytosis, no anemia PT:Aptt: WNLChem 10 + SDMA: mild elevated urea, SDMA, crea WNL Dip stick:   - pH 7  - Leuk 25/uLPro 30/dlGlucose 50/dlKetone negUbg normBld 250 ery/uLBacteria: none, confirmed on stained prepCrystals: none, confirmed on wet prep Inflammatory cells:   - WBCs > 50 per HPF  - RBCs > 50 per HPF RBCs: 1 - 3 squamous epithelial cells USG: 1.035Assessment:Sterile inflammation Ddx: neoplasia, UTI Plan: 1. Gabapentin 100mg PO BID q14d 2. Onsior 5mg PO SID TWO hours after a full meal for 6 days. If V+, D+ or anorexia stop immediatly and contact clinic 3. Recheck if no improvement in 48 hours O aware next step abdo US (specialist VS POCUS) and urine collected via cysto sent for CandS    Vital Signs