C10032020 / invoice 10000

Reason: Blood In UrineAppointment Notes: Special payment terms exist, Overdue remindersRecord complete YESUpdate to RV YES History:Presents for haematuria noted this morning. This is the second episode, the first occurred as a puppy on 19/01/2025 and resolved with antibiotics. This morning, urinated approximately five times, which is similar/more frequent than usual. One episode of straining was noted. Reported that she urinated in the cage here which owner which is unusual behaviour, suggesting urgency. Owner reports Sesha is otherwise bright, happy, eating and drinking well.Past history includes a presumed urinary tract infection on 19/01/2025. Also treated for a pedal issue approximately three weeks ago at Green Cross Vet with a course of oral steroids and a topical cream. The last dose of steroid was two weeks ago. No history of trauma. Desexed, with no signs of being in heat. Does not leak urine.No reported history of trauma. Diet consists of kibble with water added.No access to toxins/medication/poison/plants/mushroom/baits. Always supervised when outside.No allergies to medication or food.Not currently receiving any medications.Objective:- General demeanour: Bright and happy.- Cardiovascular: no murmur or arrhythmia, FP synchronous and adequate. HR 102=PR, femoral pulse S+R - Respiratory: no overt bronchovesicular sounds, normal effort, no cough/sneeze witnessed. RR normal. Panting. Vocal. - Abdomen: soft, comfortable, no organomegaly. No organomegaly. - Peripheral LNs: within normal limits. - Eyes/Ears: within normal limits.- Integument: Vulva examined, appears normal.- Oral exam: within normal limits.- Musculoskeletal: within normal limits.- Gait: ambulatory.- Neurological: within normal limits.- T 38.8 *C Assessment:Haematuria, pollakiuria and urinary urgency.- Differential diagnoses include recurrent bacterial cystitis. Underlying causes for recurrent infection (e.g. anatomical defect, urolithiasis, FB) are possible. There maybe an underlying predisposing reason for recurrent urinary tract infection. Bleeding disorder considered unlikely given no access to toxins and no other clinical signs of bleeding. Plan:Two options were discussed: 1) Empirical antibiotic therapy, or 2) Urine sampling via cystocentesis under sedation for culture and sensitivity testing. The owner elected for empirical treatment at this stage.Plan is to start a course of amoxicillin-clavulanic acid. If the signs recur within two weeks of finishing the course, or if there is another episode in the near future, further investigation will be strongly recommended. This would include sedation for sterile urine sample collection (cystocentesis) for culture and sensitivity, and an abdominal ultrasound. Further diagnostics like a scope of the urethra may be considered if needed.The owner was also counselled on a supplement, CystoPro, to consider if episodes become more frequent.Client communication:Discussed the clinical signs are consistent with cystitis (bladder inflammation). Explained the plan for empirical antibiotic treatment. Advised that if clinical signs recur shortly after treatment or become frequent, further diagnostics such as urine culture, bladder ultrasound and other tests would be necessary to investigate for underlying causes. Recommended keeping Sesha well-hydrated and quiet at home. Provided with a discharge summary.Dispensed:- Amoxiclav 500 mg tablets: one tablet orally twice daily with food for seven days.- Gabapentin capsules: one capsule orally twice daily for pain relief and mild sedation.**DISCHARGE INSTRUCTIONS FOR SASHA****Date: 14/03/2026****REASON FOR VISIT**Sasha was seen today for blood in her urine (haematuria). This is her second episode, the first being in January 2025. You reported no history of trauma/access to toxins. **EXAMINATION FINDINGS**Sasha was bright and happy on examination. Her physical examination was unremarkable. Blood was noted in her urine, along with signs of urinary urgency as she urinated in the cage which was reported to be atypical of her. There were no signs of bleeding else and there were no obvious foreign material in her vulva. We discussed the options of 1) treating empirically with antibiotics provided she has been otherwise well and it has been 14 months since the last episode. 2) further investigations with collecting urine directly from her bladder under sedation and submit for analysis and culture and sensitivity You have elected option 1) **MEDICATIONS****Amoxiclav 500 mg tablets**Give one tablet by mouth twice daily with food for seven days.This is an antibiotic to treat the suspected urinary tract infection. Please complete the full course even if Sasha appears to improve before the tablets are finished. Start when she gets home. **Gabapentin capsules**Give one capsule by mouth twice daily.This provides pain relief and has a mild sedative effect to help keep Sasha calm and comfortable. Mild drowsiness is normal. Start when she gets home. **HOME CARE**Keep Sasha well hydrated. Ensure fresh water is always available.Keep her quiet and rested at home during her recovery.Allow her regular toilet access, as she may need to urinate more frequently than usual.**WHAT TO WATCH FOR**Please contact us if you notice any of the following:Sasha stops eating or drinkingBlood in the urine worsens or does not improveSasha is straining to urinate frequently or unable to pass urineShe becomes lethargic, vomits, or seems unwell in any way**FOLLOW-UP**If Sasha's signs resolve with this course of antibiotics and do not return, no immediate follow-up is needed.If signs recur within two weeks of finishing the antibiotics, or she has another episode in the near future, further investigation will be recommended. This may include:Sedation to collect a sterile urine sample directly from the bladder (cystocentesis) for culture and sensitivity testingAbdominal ultrasound to assess the bladderFurther diagnostics such as urethroscopy if indicatedA supplement called **CystoPro** (a probiotic with cranberry extract) may be considered if episodes become more frequent. This can be discussed at a future visit.If you have any questions or concerns, please do not hesitate to contact us.Thank you for entrusting her care to us.Dr. Monica LiuEmergency Vet    Vital Signs    Weight: 25.4;