C10024562 / invoice 10000

PRESENTING/OWNERS CHIEF COMPLAINT/REASON FOR VISIT
-   Louie (5-year-old DSH): Annual health check and final F5/FIV vaccinations. Application of Bravecto Plus.
-   Lola (4-year-old Ragdoll): Annual health check and final F5/FIV vaccinations. Application of Bravecto Plus. Owner also has concerns regarding chronic sneezing and new-onset excessive drinking (polydipsia).

Consult Nurse
Rach

History
A joint history was taken for both cats.  
  
Louie (DSH, 5y 6m)  
EDDU: Normal eating, drinking, and urination.  
Vomiting/Diarrhea: No V+ or D+  
Diet: Royal Canin Urinary SO dry and wet food. Fed 3 times daily.  
Vaccinations: Presented for final F5 and FIV booster vaccinations.  
Preventatives:
-   Worming: Up-to-date with Propantol.
-   Heartworm: Due
-   Flea & Tick: Due
Current Age: 5 years, 6 months  
Current Medications: None  
Behaviour Concerns: Defecates just outside the litter tray.  
History: Indoor cat with occasional outdoor access. History of a self-limiting skin reaction to a previous topical parasiticide.  
  
Lola (Ragdoll, 4y 6m)  
EDDU: Abnormal. Eating is normal, but owner reports polydipsia (excessive drinking).  
Vomiting/Diarrhea: No V+ or D+  
Diet: Royal Canin Urinary SO dry and wet food. Fed 3 times daily.  
Vaccinations: Presented for final F5 and FIV booster vaccinations.  
Preventatives:
-   Worming: Up-to-date with Propantol.
-   Heartworm: Due
-   Flea & Tick: Due
Current Age: 4 years, 6 months  
Current Medications: None  
Behaviour Concerns: Feisty/aggressive in a clinical setting.  
History: Indoor cat with occasional outdoor access. Long-standing history of sneezing fits.

Physical Exam
Louie  
General Appearance: BAR; Bright and alert.  
Behaviour: Calm and tolerant during the examination.  
Vitals: HR: 168 bpm; T: 38.6¡C  
Hydration: normal  
BCS: 7/9  
EENT: eyes clear, no evidence of conjunctivitis, no discharge or blephrospasm; no swelling or discharge to the external ear canal, ear pinnae clear; no nasal discharge; Grade 1-2/4 dental tartar with mild gingival hyperplasia noted on a back molar.  
Cardiac: normal rate and rhythm, no murmurs on auscultation  
Resp: normal rate, normal clear sounds auscultated in all lung fields  
Abdo: comfortable on abdominal palpation, no palpable abnormalities  
Urogenital:  
Integument: no external parasites noted; no erythema or pruritis. The hair has fully regrown over a previous area of alopecia on the dorsal neck.  
Neuro: proprioception NAD; NSF  
Musculoskeletal: ROM in all joints NAD; no abnormalities on palpation  
Lymph Nodes: Peripheral LN's WNL  
  
Lola  
General Appearance: BAR; Bright but highly anxious.  
Behaviour: Became progressively stressed and aggressive, attempting to bite. Examination was ceased due to patient distress.  
Vitals: HR: 172 bpm; T: 38.2¡C; Weight: 5.1 kg  
Hydration: normal  
BCS: 7/9  
EENT: The nasal bridge appears somewhat ridged. Remainder of head and neck exam was unable to be completed due to patient temperament.  
Cardiac: Tachycardic, consistent with stress. No murmur auscultated.  
Resp: Mild sniffling noted. Lungs clear on auscultation.  
Abdo: Examination deferred due to patient temperament.  
Urogenital:  
Integument: no external parasites noted; no erythema or pruritis. A small, new scab is present on the dorsum of the nose.  
Neuro: Examination deferred due to patient temperament.  
Musculoskeletal: Examination deferred due to patient temperament.  
Lymph Nodes: Examination deferred due to patient temperament.

Client Communication from Consult Nurse
Nurse Rach took the initial history. She discussed the cats' diet with the owner, noting that feeding three meals a day was likely contributing to them being overweight. She advised cutting out the lunchtime feed and explained that the dry food, with its higher fibre content, would help keep them feeling full for longer.

Client Communication with Vet
Veterinarian: Ange
-   Diet/Weight: The vet reinforced the nurse's advice regarding the cats being overweight. She suggested either cutting out the midday meal entirely or halving the breakfast and lunch portions to reduce total daily intake, which is important for joint health and reducing the risk of diabetes.
-   Louie's Toileting: The vet discussed Louie's habit of defecating outside the litter box. After confirming the owner provides ample clean litter trays, it was concluded to be a behavioural quirk. As it is not causing a major issue for the owner, no further action was recommended.
-   Louie's Preventatives: A discussion was had regarding the previous skin reaction to a spot-on product. It was decided to proceed with Bravecto Plus, as it has a different active ingredient. The owner was advised to monitor the application site and that they have Neocort cream at home to apply if any irritation occurs.
-   Louie's Dental Health: The vet noted Grade 1-2 tartar and some gum overgrowth on a molar. It was recommended this be monitored, and a future dental procedure with dental x-rays would be beneficial. The owner acknowledged they had previously received an estimate for this.
-   Lola's Polydipsia (Excessive Drinking): This was identified as the primary concern. The vet explained that this can be a sign of several conditions, including kidney disease, liver problems, or diabetes. A blood test was strongly recommended to investigate. The cost was discussed. The owner agreed to the blood test. A thyroid test was also added to the panel.
-   Lola's Sneezing: The vet discussed potential causes for the chronic sneezing. Given the history and the ridged appearance of her nose, differentials discussed included chronic post-viral changes (from a past cat flu infection) or, more concerningly, a fungal infection such as nasal cryptococcosis, which can alter the shape of the nose. The presence of a new scab on her nose made this a differential to keep on the radar.
-   Lola's Behaviour & Deferred Plan: Lola became too stressed and aggressive to safely draw blood or administer vaccinations. The vet explained that for the safety and welfare of Lola, it would be best to stop. A plan was made to reschedule the appointment and use a pre-visit sedative. The vet prescribed Gabapentin and explained the dosing protocol (one capsule the night before, one 2 hours prior to the visit) and its safety profile. The owner accepted this plan.
-   Urine Sample: The vet explained that a urine sample would be very helpful to run alongside the blood test to better assess kidney function. The owner was provided with a Katkor urine collection kit and given instructions on how to collect and store the sample.

Laboratory/Imaging
Patient: Lola
-   Bloods: A comprehensive blood panel (CBC/Chemistry) including a thyroid level test was planned to investigate polydipsia. The blood draw was deferred to the recheck appointment due to patient temperament.
-   Urinalysis: A urinalysis was planned to be run concurrently with the blood test. The owner was sent home with a collection kit.

Assessment/Problem list
Louie:
-   Overweight (BCS 7/9)
-   Behavioural inappropriate defecation
-   Grade 1-2/4 dental disease with gingival hyperplasia
-   History of cutaneous reaction to a topical parasiticide
  
Lola:
-   Polydipsia (PU/PD) - for investigation
-   Chronic sneezing with abnormal nasal conformation - for investigation/monitoring. Differentials include chronic rhinitis vs. nasal fungal infection (e.g., Cryptococcus).
-   Fear, anxiety, and stress in a clinical setting
-   Overweight (BCS 7/9)

Treatment
Louie:
-   F5 vaccination, 1mL, administered subcutaneously over the left shoulder.
-   FIV vaccination, 1mL, administered subcutaneously over the right shoulder.
-   Bravecto Plus for medium cats, 1 pipette applied topically to the skin at the base of the skull.
  
Lola:
-   No treatments administered today.
-   Dispensed: Gabapentin 100mg capsules (#10)
-   Dispensed: Katkor non-absorbent litter for urine collection.

Plan
Louie:
-   Monitor application site of Bravecto Plus for any signs of skin irritation.
-   Implement diet change (cease midday meal) for weight loss.
-   Recheck in 12 months for annual health check and vaccinations.
  
Lola:
-   Administer Gabapentin 100mg: 1 capsule the night before the recheck appointment, and 1 capsule 2 hours prior to the appointment.
-   Owner to collect a urine sample using the Katkor kit and bring it to the appointment.
-   Recheck appointment scheduled for Saturday. At this visit, the plan is to:
    -   Perform a blood draw for a comprehensive profile including thyroid levels.
    -   Perform a urinalysis.
    -   Administer F5 and FIV vaccinations.
-   Implement diet change (cease midday meal) for weight loss.

Internal treatment plan Comms
Lola's F5 and FIV vaccines have been labelled and are being stored in the fridge for her recheck appointment on Saturday. Patient is highly fractious. Re-booked with pre-visit Gabapentin. Plan for blood draw, urinalysis, vaccinations at recheck.

Follow up notes
Next Visit: Lola is scheduled to return on Saturday, 14/03/2026, at 13:00 for her deferred procedures and diagnostics.  
Follow up phone call for: No follow-up call scheduled.

PRESENTING/OWNERS CHIEF COMPLAINT/REASON FOR VISIT
Second FIV vaccination for Louie and Lola.

Consult Nurse
Nil
  
Lola (4-year, 5-month-old FN Ragdoll cross)  
EDDU: Normal  
Vomiting/Diarrhea: No V+ or D+  
Diet: Royal Canin Urinary SO  
Vaccinations: Presented for second FIV vaccination.  
Preventatives:
-   Worming: Received tapewormer at last visit.
-   Heartworm: Not discussed.
-   Flea & Tick: No issues reported.
Current Age: 4 years, 5 months  
Current Medications: None  
Behaviour Concerns: None  
History: Was lethargic for a day following her previous vaccination.
  
Lola  
General Appearance: BAR; smaller frame than Louie.  
Behaviour: Calm and cooperative for examination.  
Vitals: HR: 180 bpm; RR: Not recorded; T: 38.4 ¡C; MMC: Pink and moist; CRT: <2 seconds  
Hydration: normal  
BCS: 6/9 (Weight: 5.1 kg)  
EENT: eyes clear, no evidence of conjunctivitis, no discharge or blephrospasm; no swelling or discharge to the external ear canal, ear pinnae clear; no nasal discharge; Moderate tartar and associated gingivitis noted, particularly on caudal dentition.  
Cardiac: normal rate and rhythm, no murmurs on auscultation  
Resp: normal rate, normal clear sounds auscultated in all lung fields  
Abdo: comfortable on abdominal palpation, no palpable abnormalities  
Urogenital: Female neutered, NSF.  
Integument: no external parasites noted; no erythema or pruritis  
Neuro: proprioception NAD; NSF  
Musculoskeletal: ROM in all joints NAD; no abnormalities on palpation  
Lymph Nodes: Peripheral LN's WNL

Client Communication from Consult Nurse
Nil

Client Communication with Vet
-   Vaccination Plan: Confirmed this visit was for the second of three FIV vaccinations. The final vaccine is scheduled in 2 weeks. The owner noted both cats were lethargic for about a day after the previous vaccine, which was acknowledged as a normal, transient side effect.
-   Louie's Skin Reaction: Discussed the bald spot on Louie's neck, which developed after a topical flea treatment. It was recommended to avoid topical products for him in the future due to this sensitivity. The option of ordering an oral parasiticide was mentioned.
-   Weight Management: Louie's weight of 5.9 kg and Body Condition Score of 6/9 were discussed. The owner was advised that he is slightly overweight and that a leaner body condition is ideal for long-term joint health and to reduce the risk of diabetes. A target weight of 5.3-5.5 kg was suggested. Both cats were noted to be slightly overweight.
-   Dental Health: Dental disease was identified in both cats. Lola presents with more visible gingivitis, but the owner is more concerned about Louie as he has stopped chewing his food. It was agreed to prioritise a dental procedure for Louie based on this clinical sign. A dental procedure for Lola was also recommended to be performed soon to address her tartar and gingivitis.
-   Diet: The owner was reassured that the Royal Canin Urinary SO diet is an excellent choice for both cats. The mechanism of acidifying urine to prevent crystal formation in males was explained, and it was confirmed that the diet is also safe and appropriate for Lola.

Assessment/Problem list
Lola
-   Dental disease (moderate tartar and gingivitis)
-   Mildly overweight (BCS 6/9)

Treatment
-   Lola: FIV vaccine administered SCIS

Plan
-   Return in 2 weeks for the final (third) FIV vaccination for both Louie and Lola.
-   Schedule a dental procedure for Louie as a priority.
-   Schedule a dental procedure for Lola.
-   Continue feeding Royal Canin Urinary SO diet to both cats.
-   Monitor weight with the goal of gradual weight loss for both cats.
-   Investigate ordering an oral flea preventative for Louie if required.
  
(GHC in 6mths)

Internal treatment plan Comms: Nil


Follow up notes
-   Rebook for final FIV vaccination in 2 weeks.
  
Follow up phone call for: Nil

PRESENTING/OWNERS CHIEF COMPLAINT/REASON FOR VISIT
LOUIE & LOLA: Annual health check, vaccinations (FIV & F5), and FIV/FeLV testing.  
LOLA: Owner notes she drinks and urinates frequently.

Consult Nurse
Maddy

History
LOLA:  
EDDU: Normal appetite. Owner reports she drinks and urinates a lot (polydipsia/polyuria).  
Vomiting/Diarrhea: No V+ or D+  
Diet: Royal Canin Urinary S/O (wet and dry).  
Vaccinations: Lapsed, last vaccination was in October 2023.  
Preventatives:
-   Worming: Lapsed
-   Heartworm: Lapsed
-   Flea & Tick: Lapsed
Current Age: 4-5 years  
Current Medications: None  
Behaviour Concerns: None  
History: Indoor/outdoor cat. Lives with Louie and a dog.

Physical Exam
LOLA:  
General Appearance: BAR  
Behaviour: Calm during examination.  
Vitals: HR: 180 bpm; RR: normal rate; T: 38.9¡C; MMC: Pink; CRT: <2 seconds  
Hydration: normal  
BCS: 6/9  
EENT: eyes clear, no evidence of conjunctivitis, no discharge or blephrospasm; de-sexing tattoo in ear, no swelling or discharge to the external ear canal, ear pinnae clear; no nasal discharge; Grade 0-1 dental disease. Minor staining on the upper right carnassial.  
Cardiac: Tachycardia noted, consistent with stress. No murmurs on auscultation.  
Resp: normal rate, normal clear sounds auscultated in all lung fields  
Abdo: comfortable on abdominal palpation, no palpable abnormalities  
Urogenital: Owner reports polyuria.  
Integument: no external parasites noted; no erythema or pruritis  
Neuro: proprioception NAD; NSF  
Musculoskeletal: ROM in all joints NAD; no abnormalities on palpation  
Lymph Nodes: Peripheral LN's WNL

Client Communication from Consult Nurse
(-)


Client Communication with Vet
-   Discussed the plan for FIV/FeLV testing and vaccinations for both cats. Explained the blood draw process from the jugular vein.
-   Confirmed that both cats tested negative for FIV and FeLV.
-   LOLA: Discussed the owner's report of increased drinking and urination. Explained that while she is young, this warrants investigation for underlying issues such as kidney disease. Recommended collecting a urine sample to check its concentration. Also discussed that a blood test to check kidney values would be the gold standard. The owner accepted this recommendation.
-   VACCINATIONS: Explained the booster protocol for both cats. As they are lapsed, they will require a course of vaccines.
-   PARASITE CONTROL: Discussed the need for flea, tick, and worming prevention. Recommended Bravecto Plus spot-on and a tapewormer (Praziquantel) for gecko tapeworm.
-   COST: Quoted a total of $520 for both cats today, which covers the consultation, FIV/FeLV tests, the first dose of the F5 and FIV vaccines, and parasite control. The owner was advised this can be submitted to their insurance.

Laboratory/Imaging
In-house test: FIV/FeLV snap test performed on both cats.  
Results: Both Louie and Lola tested negative for FIV and FeLV.

Assessment/Problem list
LOLA:
-   Lapsed vaccinations
-   Polydipsia/Polyuria for investigation
-   Parasite prevention required

Treatment
LOLA:
-   F5 vaccine (1st dose) administered.
-   FIV vaccine (1st dose) administered over the left shoulder blade.
-   Praziquantel (tapewormer): Partially administered in-clinic.
  
BOTH:
-   Bravecto Plus spot-on recommended, to be dispensed at the next visit as correct size is not in stock.
-   Praziquantel tablets dispensed for home administration.

Plan
-   Return in 2 weeks (Thursday at 8:00) for the 2nd FIV vaccination for both cats.
-   Return in 4 weeks from today for the F5 booster and 3rd FIV vaccination for both cats.
-   LOUIE: Schedule a dental procedure. An estimate will be provided.
-   LOLA: Owner to collect a first-morning urine sample for urinalysis. Consider a blood test to assess kidney function.
-   Administer dispensed Praziquantel at home.
-   Start Bravecto Plus at the next visit.
  
(GHC in 6mths)

Internal treatment plan Comms


Follow up notes
Recheck appointment booked for Thursday in 2 weeks at 8:00 for 2nd FIV vaccination for both cats.  
Follow up phone call for: