C10021989 / invoice 10000

Reviewer

Species:CANINE

Breed:American Staffordshire Terrier Cross

Age (years):7

Diagnosis or signs:gap only

Consult notes

Admitted: ACTH stim  & recheck ears
7:30-7:45 admit 
Confirmed JC




ACTH Stim Test:-
When was last dose of Trolistane: 6:30am
     0 Hour Blood Sample taken by: TM
     Give Synthetic ATCH IV by: TM
     1 Hour Blood Sample taken by: REB

ears checked as much as dog will allow - canals are clean

blood for ACTH stim test taken in duplicate for inhouse and lab testing to compare results, client only charged for one set.

Idexx to compensate clinic for having to run this test so have removed most fees today, only left cost of drugs and minimal hospital fee (JB)

Animal clinical history (3 most recent)

2026-02-12T00:00:00Z 09:03:00

review ACTH stim results - levels based upon lab results are excellent, but there is a trend of the dog's values coming down over time and despite lower dose and lower now than last year. therefore r/c in 3mths. owner to monitor for recurrance of skin issues and r/c immediately if any eruptions occur.

current trilostane dose is 15mg sid

2026-02-11T00:00:00Z 07:55:00

Admitted: ACTH stim  & recheck ears
7:30-7:45 admit 
Confirmed JC




ACTH Stim Test:-
When was last dose of Trolistane: 6:30am
     0 Hour Blood Sample taken by: TM
     Give Synthetic ATCH IV by: TM
     1 Hour Blood Sample taken by: REB

ears checked as much as dog will allow - canals are clean

blood for ACTH stim test taken in duplicate for inhouse and lab testing to compare results, client only charged for one set.

Idexx to compensate clinic for having to run this test so have removed most fees today, only left cost of drugs and minimal hospital fee (JB)

2026-01-29T00:00:00Z 07:48:00

Admitted: ACTH Stim Test - min 2 hour stay
discharge appt booked.

Check ears - been shaking and scratching for 1 week

ACTH Stim Test:-
When was last dose of Trolistane: 6:45am 
     0 Hour Blood Sample taken by: 
     Give Synthetic ATCH 0.2mLs IV by: 
     1 Hour Blood Sample taken by: 

both samples very low today. reduce trilostane to 15mg sid and r/c ACTH stim in 1wk

bilateral otitis externa - otomax bid 14days then r/c

Previous claim history (15)

Date	Claim #	Diagnosis
2026-01-29	C09827725	HYPERADRENOCORTICISM ("CUSHING'S")
2026-01-29	C09827725	EAR INFECTION
2025-12-30	C09690602	HYPERADRENOCORTICISM ("CUSHING'S")
2025-07-31	C9032536	CUSHINGS DISEASE
2025-07-09	C8941880	CUSHINGS DISEASE
2025-07-09	C8941880	SKIN LESIONS
2025-07-09	C8973963	CUSHINGS DISEASE
2025-06-17	C8847099	HYPERADRENOCORTICISM ("CUSHING'S")
2025-06-05	C8804542	HYPERADRENOCORTICISM ("CUSHING'S")
2025-05-29	C8772112	POLYURIA/POLYDIPSIA - PRESENTING COMPLAINT
2025-05-23	C8752082	HYPERADRENOCORTICISM ("CUSHING'S")
2025-05-22	C8745828	POLYURIA/POLYDIPSIA - PRESENTING COMPLAINT
2025-05-20	C8735297	POLYURIA - PRESENTING COMPLAINT
2025-05-19	C8727827	POLYURIA - PRESENTING COMPLAINT
2024-11-28	C8129560	POLYURIA - PRESENTING COMPLAINT

Line items(lines with upstream diagnosis are skipped by the model)

Line	tstarc	Amount	Date	Upstream diagnosis
10000	tstarc_hospitalisation	25.00	2026-02-11	—
20000	tstarc_synacthen	75.25	2026-02-11	—

UPM+

DG02293HYPERADRENOCORTICISM ("CUSHING'S")DSTP_hyperadrenocorticism_(cushing's_disease)

Variant (sleepy_king)

HYPERADRENOCORTICISM ("CUSHING's")

DSTP_hyperadrenocorticism_(cushing's_disease)

Conf: 0.940

Threshold: 0.18

Above: ✓

Correct?

Yes No