C10030757 / invoice 10000

Reason: Uti Still GoingAppointment Notes: Overdue remindersOr that in the last few days that he seems to be toileting insideVerified: NoHISTORYPresenting for: Beau presented for inappropriate urination occurring for 2-3 days in a row. Owner reports he walks approximately 10-15 metres towards the door but urinates near the door rather than going outside, which is not his normal behaviour.Historical Conditions: Recent UTI treated with antibiotics (Amoxyclav) which was completed 2 days prior to this visit. Received injection at previous visit 3 days ago.Current Meds: Recently completed 5-day course of Amoxyclav (1 tablet BID). No current medications.EXAMMentation: BARBehavioural: Very well behaved and cooperative. Allowed catheterisation without complaint and was described as such a good boy. Tolerated anal gland expression well but became distressed during cleaning attempts around his rear end, crying and sitting down when wiped.Rectal: Anal glands expressed - patient tolerated procedure well but resisted cleaning afterwards. Some anal gland secretion noted around tail area post-expression. Digital rectal exam performed to assess prostate - no palpable enlargement detected, though examiner noted finger reach limitations.Diagnostics: Sterile urine sample collected via urinary catheterisation due to difficulty obtaining sample with needle aspiration. Sample to be submitted for culture and sensitivity testing.ASSESSMENTInappropriate urination - DDx: recurrent/persistent UTI, urolithiasis, age-related sphincter weakness/incontinencePLANDiagnostics:- Urine culture and sensitivity submitted ($370) - results expected within one week- Abdominal radiographs recommended if urine culture negative to assess for bladder stonesNew Meds/Tx:- Amoxyclav 1 tablet BID for 7 days (same antibiotic as previous course). Start with one tablet this evening, then continue twice daily 12 hours apart. May need to be discontinued if culture shows resistance.Additional Discussion:- If urine culture negative and radiographs show no stones, will trial incontinence medication for age-related sphincter weakness- Stones, if present, would require surgical removal and dietary management based on stone analysis- UTI could have caused stone formation due to urine pH changes, or stones could be causing recurrent UTI- Patient going to boarding kennel while owners travel - kennel staff able to administer medication and monitor- Recommend pee pads near door area where accidents occurring- Gentle cleaning of rear end at home with warm wet towel due to anal gland secretionClient Comms:- Monitor for straining or blood in urine - contact clinic immediately if these signs develop- Culture results will determine if current antibiotic appropriate or if resistance present- Boarding facility and owners to watch for any deterioration in condition- Will contact with results and next steps within one week    Vital Signs