C10025652 / invoice 10000

Reason: Accidents In The HouseAppointment Notes: stabilization okaccidents in the house, started 2 weeks ago with just urinating but this evening multiple bowel movements too. tail tucked.panting started this eveninghx anxiety takes gaba/fluoxitine, left FHO, skin issues takes apoquel as needed, and GI/HGE39kgBART 38.0P 100R pantMM pink 1-2sRecord Entered by: MEL History:Has been having accidents inside the house over the last 2 weeks. Bruce is normally very well at alerting the owner when he needs to defecate but he has recently started urinating in the house. The urination appear voluntary as he will empty his entire bladder and then give the owner a 'shameful look'. He also defecated once. Owner believes he is incontinentBruce has a history of anxiety and receives gabapentin and fluoxetine. He had a L FHO previously. Has skin issues for which he receives apoquel. Also has a history of HGE.  Physical Examination: Demeanour: BAR. Barks in the presence of the ownerBCS: 4/9EENT: unremarkablePeripheral lymph nodes: small, symmetrical, not enlargedIntegument: clean coat, no parasites/debrisCardiovascular: HR 110, no appreciable murmurs or arrthymia, MM pink, CRT<2sRespiratory: panting but then RR22 when moved away from the owner. Abdominal: no discomfort on abdominal palpation. No appreciable masses. Bladder smallMusculoskeletal: ambulatoryNeurological: normal mentation and gait. CNs intact. No pain on spinal palpation. CP normal. Anal tone presentRectal: faeces removed. Finger does not reach far enough to palpate anything. Temp 38Urogenital:externally unremarkable Assessment:Problem list:- periuriaDdx: LUTD - cystitis including infection, cystoliths, prostatic disease less likely, neoplasia- defecated inside - well formed faecesThe urination sounds voluntary as there is no random dribbling or history of traumatic injury or wobbliness. Primary suspicion is neurological disease.POCUS: possible mild hyperechogenicity dorsally in the bladder but no shadowing. Unable to collect urine via cysto - frightful of the needle stingRecommended urinalysis. Explained to the owner the potential differences in urinalysis in urine collected via urination vs cysto vs ucath.Urine sent to Vetnostics. Advised against empirical antibiotics. Advised the owner if the urinalysis is unremarkable then abdominal imaging is recommended.  Plan (incl. alternative options): Await urinalysis - contact owner with result    Vital Signs