C10028862 / invoice 10000

Reason: NM - Solensia Inj (JP)Appointment Notes: changed from solensia to an ultrasoundHistory: bloods from Nov 2025Leucopaenia 3.3Neutropaenia 2.3Lymphopaenia 0.6Incr SDMA 18Incr creat 0.21T4 30Blood in urine at that time alsoStill urinating outside the litterbox, no blood seen. Eating okDramatic wt loss esp hind endAlso seems v sore  - gabapentin no longer really working allows o to massage her -stands stillExamine: not possible to examine conscious - boxed down isoflurane as all injectable sedations cause prolonged dysphoria, good recovery from iso sedation in pastSedated exam - mms pink, crt 1s, has some dental disease-tartar and gingivitis upper molarsLnns okAbdo palp - firm faeces, large bladder, small shrunken left kidney, right kidney larger, irregular shapeHr 140, no murmur, rr 20Normotensive under sedation initially, then dropped lowPalpation of limbs, some reduced ROM both elbows, hip bones protrudingT=37.1Wt 3.1kg - has lost 500g since last weighed. Procedure: Abdo ultrasound - liver/gall bladder nadStomach empty, mucosa 2.4mmSmall intestines largely empty of ingesta, mucosa 3.1mmDuodenum empty of ingesta, mucosa 4.4mmColon - formed faeces, mucosa 2.1mmPancreas appears normalSpleen rel enlarged, normal echotextureLeft kidney v small, abnormal architecture, 6mm of pelvic fluid accumulationRight kidney larger, misshapen, also 5mm of renal pelvic fluid accumulationAdrenals not observedNo free fluidNo mesenteric lymhadenopathyUrinary bladder, large, sl polypoid changes in wall - sample collected by cystocentesisBloods also taken for rpt TAHP to idexxTreatment: solensia 1 vial s/cPlan: await bloods/urine c/s - check with caroline if already on renal diets    Vital Signs    Weight: 3.1;       

Reason: bloodsBloods from today show significant worsening of azotaemia compared with NovemberCBC lymphopaenia (likely stress)BiochemSDMA 19 (was 18)Creat 0.32 (was 0.21)Urea was prev normal rangeT4 normal 30Plan: Ideally hospitalise for iv fluids but tricky with her temperamentRecc add hydracare sachetsIs already on renal sachetsMay requ s/c fluids to be given at home?Awaiting urine c/sIn mean time start on amoxyclav    Vital Signs