C10031613 / invoice 10000

--- 14/03/2026 09:32:16 EW: O dropped off faecal sample. Sent to vetnostics for PCR and faecal floatation.--- 14/03/2026 09:35:58 EW: Called O for payment. O to ring back or come in to pay.    Vital Signs    

Reason: Sash Hx Attached - CfProblem list 1/ Persistent hyporexia and lethargyNon-specific and lack of other gastrointestinal signs (formed stool, no regurgitation) may makeprotracted recovery from gastroenteritis less likely. May be concerning for concurrent disease processas this is unexpected for a dog presenting with poorly controlled diabetes without ketosisDdx: GI (protracted recovery from gastroenteritis, oesophagitis, GI ulceration, may be considered givenstructurally normal GIT on CT), ExtraGI (pancreatitis) is considered less likely given CT was performed 2days after onset of illness and should show changes. Hypoadrenocorticism has been excludedCT scan was reviewed again on 6/3 and did not find obvious reasons for persistent hyporexia/pain inimages acquired. The head and limbs were not imaged due to presenting signs ofvomiting/regurgitation and haemorrhagic diarrhoea2/ Reactive on abdominal palpation, spinal palpation and palpation of HLs. Also reported difficulty getting into the car(vocalising)ddx: behavioural vs pathologic (MSK - IMPA, DJD vs abdominal pain vs myositis vs less likely neuro.CT scan of the spine was unremarkable apart from transitional L1 vertebra with partial and hypoplasticleft rib. Dural mineralisation (considered incidental). Possible early CF joint OA.Due to Beau's reactive temperament, it was difficult to assessFurther investigation could involve CT scan of the pelvic limbs, CRP was mildly elevated but not highenough suggest clinically relevant systemic inflammation3/ Acute vomiting/regurgitation and haemorrhagic diarrhoea - resolved - acute gastroenteritispossible more chronic history of intermittent diarrhoea described by ownerSuboptimal B12 raises suspicion for chronic enteropathy4/ Diabetes mellitus - currently managed with 18U q12 Toujeo twice dailydiagnosed June 2025 after presenting for lethargy, exercise intolerance and PDcontinuous BG sensor has been placed and patient will be discharged with it - Assess BG over the next1-2 weeks remotely once patient recovers from current acute episodecgm monitoring in hospital showed euglycaemia today5/ Suspected hypothyroidismOct 2021 (alopecia, weight gain) TT4 10 (13-52) on in-house pre-anaesthesia blood test forpenetrating FB in foot. TSH performed 0.64 (0.02-0.5), fT4 not measured.Previous reported diarrhoea to different formulations of levothyroxine (currently on Eltroxin 300mcgq12h) - previously trialled forthyron, oroxinemonitoring of thyroid hormone levels every month (4-6 hours after thyroxine dose) then q6-8mo ifstable6/ Splenic cystic lesions (CT imaging 2/3/26)7/ Mild hypoproteinaemia (low normal albumin and globulins)suspected due to GI losses8/ Mild biochemical hepatopathyMildly elevated ALT is suspected to be reactive hepatopathy secondary to enteropathyMild ALP elevation could be due to metabolic hepatopathy (DM, possible hyperadrenocorticism) thoughthis has been assessed(ACTH-ST idexx performed 21/6/23 - 0h 96, 1h 199)9/ Obesity10/ Recurrent pyoderma11/ Elevated temperature (mild) - 39.3 today12/ Pyrexia vs hyperthermia (stress in hospital, arctic breed, obese)Beau is reported to have started eating since yesterday and seems brighter in himself.Plan: 11-03-2026 3:24:29pm, Dr Sherilyn KeeMedications1/ Toujeo 18u q12h2/ Thyroxine 300mcg (1.5x eltroxin 100mcg) BID3/ Maropitant 160mg PO SID4/ Prokolin 7mL BID PRN - stop for now5/ Ondansetron 24mg TM q8-12h PRN6/ Paracetamol 750mg PO q8-12h7/ Cobalazorb 1000 ug q24h with foodBloods for repeat CBC and biochemistry have been collected and refrigerated in hospital. Held sending currently asowner reports improvement at homeIf suspicion for ongoing pain of unknown origin is high, CT of the pelvic limbs and arthrocentesis may be consideredOngoing cgm monitoring with insulin dose changes until Beau's glucose levels are well controlledDiet: offer cooked/commercial foods to tempt feed. Avoid raw.Supplement B12 for 12 weeks total and recheck 3-4 weeks after supplementationIf not eating, contact the hospital for advise on insulin administrationDischarged with interstitial glucose monitor - remote monitoring of blood glucose as and after beau recovers.re: hypothyroidismOngoing monitoring of thyroid hormone levels every month (4-6 hours after thyroxine dose) thenq6-8mo if stable. Ideally sending out blood sample to a labContact the hospital if concerned----------------------------------13/03/2026 12:52:53 IP:  Eating, carrots potatoes, peas and salmon. Has been going outside comfortably with a dog walker. Has some soft poops as reported from the walker. O to bring in sample if it continues (Vetnostics). Blood glucose was stable for the first time at 22mmol/l. O said that he has been giving 22IU of insulin? SASH reports say 18IU. Confirmed with SASH and it should be 18IU. Freelibre Sensors due for replacement  Tuesday. O to chat to SASH vet today    Vital Signs    

Reason: RecheckAppointment Notes: running 5 mins late--- 05/03/2026 14:53:34 MN:Phone conversationAte last tuesday night after sash visit Lethargic todayWent for a dog walk and he was very clow and needed breaksReading are high about 29 mmol/L 1st thing this morning Now 3pm BG is 23 mmol/LHas been drinking water No vomiting O gave prozinc last night Recommended coming for recheck to check vitals and see if he needs to be hospitalisedHistory: - Diabetic patient on insulin therapy- Recent hospitalization at SASH with CT scan and blood work performed discharged on TuesdayWas discharged withProzinc insulin 90U SID at night --> o didn't give it on TUESDAY as per SASH's indications, but gave it last night Thyroxine 300mcg (1.5x eltroxin 100mcg) BID -> has been having it with yogurth but didn't  touch it todayMaropitant 160mg PO SID --> didn't give it today as he wasn't vomiting Prokolin 7mL BID  --> didn't want to touch any of this Ondansetron 24mg TM q8-12h PRN --> has had 2 doses of this Paracetamol 750mg PO q8-12h Cobalazorb 1000 ug q24h with food had this - Glucose readings: 13.9 on Tuesday, 24.2 this morning, current reading 25.3 during consult 4pm - Last Ondansetron given at 2:00 pm- No V+ and no D+ since discharged from SASH- Dark feces noted on surface, yellowish underneath (Wednesday)- Patient very thirsty - Hasn't eaten since Tuesday night. No food all Wednesday and no food at all today, owner offered chicken and salmon and yogurth which he normally loves- Required breaks during walks today with dog walker- has been drinking a lot +++- lethargic at home, although seems restlessExamination:- Mentation: Alert, friendly, picky with treats, only wanting small pieces of turkey treats- Lymph nodes: NAD- MM: Pink and moist- CRT: -2 Sec- Chest auscultation: Clear, no heart murmur- Abdominal palpation: unable to feel detail as obese- Musculoskeletal: not assessed- Dental: not assessedLaboratory: Yes -  free catch urine + BG reading during consult 25.3 Urinalysis (inhouse) --> Free catchColor: yellow USG: 1032PH 6 Leu 2+Pro -veGlu 4+Ket 2+UBG -veBIL 1BLD 1+Assessment: anorexia, hyperlucaemia, ketonuriaKetonuria due to poor glucose control. Underlying gastroenteritis likely contributing to metabolic instability. Current insulin may not be working effectively anymore +/- poor owner compliance. Patient requires stabilization with IV fluids +/-  rapid-acting insulin and ketonuria controlMay need insulin type change from current regimen to BID dosing.09/03/2026 12:16:18 CF: Phoned to advise gap ready to pay. O will drop by clinic likely this afternoon Plan:- Referral back to SASH for diabetic ketoacidosis management- IV fluid therapy, rapid-acting insulin to control glucose and ketones- Blood work monitoring- Possible insulin change to different type - Fecal sample collection when possible to rule out underlying parasites/infections for chronic GE- Continue current medications as prescribed- Recheck with internal medicine specialist Dr. Jody- Monitor eating and drinking at home05/03/2026 18:20:28 IP: Hx emailed to SASH Alex--- 06/03/2026 17:06:36 MN:Called John for a FU, Beau is still at SASH, he's going to see him tonight and find out if he's taking him home or notFrom SASH we got an update saying that they're going to change the insulin but John said that they're trying to rule out some other disease, but he didn't remember which, Will FU with a nurse tomorrow morning to see if there's any updates08/03/2026 09:37:23 IP: left vm, sent txt (f/u)Eating small amounts of air dried lambNo v+ or d+O reports he is quite flat but has ann appt with SASH tmr at 10amStarted on a new insulin (Solarstar) pen . Started at 18IU the yesterday sash said to drop down to 12IUBG started at 3.1mmol/l  thhen insulin given andovernight went to 18mmol/l to averaging 13-14mmol/lReq hx from sash    Vital Signs    Weight: 54.8;