C10025688 / invoice 10000

Appointment Notes: Special payment terms exist, Overdue remindersHistory: History: Diagnosis : 1. Non-associative non erosive IMPA based on joint cytology and CRP 15/12/25. Point joint fluid culture negativeConcurrent diagnostics:- AUS: no clinically significant findings- Thoracic radiography: multi-modal interstital to alveolar pattern of the cranial lung lobes; suspect aspiration pneumonia- Radiography of the R and L crus: no evidence of erosive disease2. Suspect chronic enteropathy; Acute diarrhoea at time of presentation for IMPA. Hypocobalaminaemia documented 17/12. 3. Pre-existing recurrent febrile episodes with neck pain throughout 2025, responsive to empircal prednisolone trial, thus similar immune mediated disease (IMPA or SRMA) suspected, but no formal investigations performed; see previous hx for details. Current medications :1. Prednisolone 30mg PO SID (dose reduction from 40mg PO SID on 9/1)2. Leflunomide 60mg PO SID (dose reduction from 80mg PO SID17/12  given diarrhoea)3. B12 1000mcg PO SID starting 9/1Current diet: Hill's Gastrointestinal Biome (dry and/or tins) Appetite : Normal to increasedEstimated percentage DER : 100%Thirst : Increased, Approx 1.5L per dayUrination : Increased but no accidentsFaecal frequency : NormalFaecal consistency : Score 2-3Demeanour : BAROther clinical signs : Leah reports energy levels are lower than  usual (Estimates 95% of normal); less keen on walks, and not greeting owners. Also notes more painting and muscle wasting. In general, Butters is still playful and very food motivated. No gastrointestinal signs since exclusive feeding of Hil's GI Biome.Examine: Weight : 29.8kgBody condition score : 5/9T:  38.3 RR:  Pant HR: 80  MM colour: Pink   CRT    1Integument: NormalEyes: Normal.Nose: Normal; healing scabs over nasal planum, which owner reports from playing from scratched up toy.Ears: NormalOral: Normal. Lymph nodes: Peripheral lymph nodes palpably normalCardiac: No murmurs or arrythmias. Femoral pulses synchronous bilaterallyRespiratory: Panting. Previous respiratory stridor not noted today. Bronchovesicular sounds to all quadrants.Abdominal palpation: Comfortable palpation.Rectal examination: NormalNeurological: Anxious mentation, normal posture and gaitMusculoskeletal: MCS 1/3. Free flowing gait. All appendicular joint palpation normal, non-painful. Normal ROM of the cervical spine.Laboratory:                                          12/12           6/1      13/2Hct L/L (RI 0.37 - 0.55)	                0.32             0.34       0.37Seg Neut x 109/L (RI 3.1 - 10.3)	7.7	   8.7	  7.6	Monocyte x 109/L (RI 0.2 - 1.0)	 0.3	  1.2	 0.8Platelet x 109/L (RI 200 - 500)	 	 22	  303           308ALT IU/L (RI 13 - 98)	 	  45	   1681     1212	 ALP IU/L (RI 0 - 182)	 	  59	   782         568CRP mg/L (RI<10)                                     105           <10         <10   Assessment:  Plan:  Communication:    Vital Signs    Weight: 31.0;