C10023525 / invoice 10000

Notes: GLDRAFTHistory: Tom is presenting for repeated ACTH stim and repeated BP doppler reading following reduction of trilostane to 20mg PO BID.Tom is managed by IM for hypertension, proteinuria & biochemical hepatopathy &hyperadrenocorticism.18/07/25: Increased PU/PD, pica, coat changes, pruritic ears, and possible early cognitive dysfunction. BP readings ranged from 145–190 mmHg. Repeat bloodwork showed static hepatopathy, persistent hypertriglyceridaemia, and elevated cholesterol. Proteinuria remains moderate (UP:C 6.2) despite improved BP. Urine culture identified E. coli and Tom was subsequently commenced on amoxicillin-clavulanic acid.29/08/25: Presented for LDDST, BAST, repeat urine culture, triglycerides and BP monitoring. Ongoing polyphagia, PU/PD. BP 180mmHg. Serum bile acids returned as WNL, static hepatopathy, elevated cholesterol. LDDST was consistent with hyperadrenocorticism, urine culture -ve. Trilostane 30mg PO SID was commenced. 10/10/25: Tom has been well at home with less ravenous appetite and polydipsia. Panting remained static. ACTH stim showed ideal control of hyperadrenocorticism with improved UPC of 3.3. Amlodipine was increased to 10mg BID PO after discussion with Fiona - cardiologist10/02/26: Tom was clinically well on his medication regime. The ACTH stim showed oversuppression, so trilostane was adjusted to 20mg PO BID.Today, OR Tom has been going well, he has been a bit more painful recently (Hx of hip dysplasia). Brother Milo is on Pregabalin, O has started to give Tom 25mg Pregabalin SID. Had Vetoryl and Amlodine this morning @ 7am, Pimobendan and Clopidogrel held. Current diet: Hills i/d wet + RC gastrointestinal dry Past Hx:Other management:ARH Oncology for his presumed AGASACA (L anal gland sacculectomy excision 5/12/23), with thickening of the R anal sac. VSS cardiology for MMVD GP vet for his hip dysplasia which is managed medically.Oncology: - April 2024: 2-3mm masses palpated bilaterally at left surgery site and right anal gland- July 2024: Focal LN U/S noted enlargement of a LN to the caudal left abdomen, measuring 0.42 x 0.84cm in size. Recommended repeat rectal examination in 6 weeks.- February 2025: No obvious lymphadenopathy of R MILN as previously noted, no other evidence of metastatic disease. Hepatopathy suspected with rounded lobar margins and very subtle change to echotexture. Very small subtle hypoechoic lesion spleen - open Dx, favour benign aetiologyCardiology: - October 2023: diagnosed Stage B2 MMVD with mild tricuspid regurgitation - diagnosed 13/10/23. Last echocardiogram Nov 2025. Current Medications:- Trilostane 20mg PO BID - Benzapril 20mg (AM), 10mg (PM) PO - Amlodipine 10mg BID PO - Clopidogrel 37.5mg SID PO - Pimobendan 5mg BID PO - Pregabalin 25mg BID PO- PMP otic 1.5ml bilaterally BID - used intermittently, full course not complete - 4cyte - Beransa @RVExamination findings: T:  38.4 C              MM: Pink, moistP:  132 bpm          CRT: 1-2sR:  Panting Demeanour: BAR, anxiousHydration: Euhydrated Weight: 18.3kg (-0.7 kg)Body Condition Score: 6/9Muscle Condition Score: 2/3, generalised muscle wastage. Cardiovascular: Grade II-III/VI LHS apical systolic murmur, no arrhythmia noted, SSFPRespiratory: WNLAbdomen: WNLOral exam: periodontal disease 3/4Ears: Otoscopic examination deferred, no erythema noted externally, moderate hair in canal.  Eyes: Protrusion of nictating membrane OU (L>R), no discharge noted. Integument: ~2cm lesion R caudal thigh present, FNA sampling deferred, grossly consistent with sebaceous adenoma. Lymph nodes: WNLGait: WNLNeurological: Full exam not performed. Mentation appropriate. No overt dysfunction. Rectal: NPTreatment: Synacthen 5ug/kg IV @1100Laboratory: BP (size 4 cuff; LPL) 155-160ACTH stim: taken at 0 and 1hr post synacthen.Awaiting QML resultsProblem list: - Hyperadrenocorticism - Systemic hypertension - managed- Proteinuria  - not assessed- Biochemical hepatopathy - not assessed- Hypercholesterolaemia - not assessed- PU/PD - improved - Stage B2 MMVD- L AGASACA (suspected) anal sacculectomy performed 05/12/23- Palpable mass/thickening ~2mm at RHS anal sac (static)- Otitis externa malasezzia - KCS OU - R caudal thigh mass (suspect sebaceous adenoma) Assessment: Tom continues to have well-managed hypertension. Awaiting results of ACTH stim to determine if the reduction in trilostane has increased the cortisol response.Plan:Awaiting ACTH stim result.Needs more Fortek. - Trilostane 20mg PO BID- Benzapril 20mg (AM), 10mg (PM) PO - Amlodipine 10mg BID PO - Clopidogrel 37.5mg SID PO - Pimobendan 5mg BID PO - Pregabalin 50mg BID PO    Vital Signs