C10032394 / invoice 10000

Appointment Notes: incontinence for quite a while now —Subjective:Presented for incontinence faecal and urinary Has been ongoing for past 18m but recently worsenedStill good appetite, drinking normally. O reports it used to be the occasional wee or faeces in the kitchen overnight. Now she is going in her bed where she sleeps. Thinks she is unaware of this when she is sleepingSeems confused trying to get out of the doggy doorGenerally slowing down becoming stiffer and sorer. Also deaf and blind. Medications: Vivotonin only BID, Zydax q3m, also has eyedrops from VOR. —Objective: BAR. Good girlHR/PR/CV: 132, no murmur, matching MM/CRT/Hydration: pink moist, <2, adequate RESP/RR: no wheezing or cracklesGIT/UG: abdominal palpation comfortable and unremarkable. Bladder small and comfortable.  Skin/Ears: NAD M/S:  generally stiff and slow, short strides. Comfortable on ROM and no lameness. Eyes: Nuclear sclerosis. Cloudy corneas, no full assessed today. Dental: G3-4 Lymph Nodes: WNLBCS: 6/9—Assessment:Urinary and faecal incontinence DDx. kidney or liver disease, inflammatory, UTI, cancer (GI lymphoma, other neoplasia), secondary to OA pain, behavioural or dementia, otherDeafBlind DementiaOA ----Discussion with O:Discussed QOL. O think her QOL is still good and does not mind cleaning up after her. Explained will need to rule out clinical cause- UTI, CKD etc and if unremarkable there may be some conservative management to help. Explained unlikely to be a cure for all of her signs. Unfortunately, a lot of the changes in Taffy (blind, deaf, dementia, OA) are irreversible. Can manage her comfort but if QOL declining at some point it may be kindest to say goodbye. O does not want to let her go for being incontinent. Aware if QOL declining will be a fair option to say goodbye. ---Laboratory:How was the sample collected: free catchColour: pale yellowTransparency:  clear USG:  1012PH: 7.0Urobilinogen: normal Protein: 100mg/dLBlood: negative Ketone: negative Bilirubin: negative Glucose: negative Sediview images: NADIs Sedivue stain required: n/aWet prep (if Sedivue images crowded): NADDiff Quik smear: no rods or cocci seen. ---Phone call: 14/03/2026 1:07:57 PM KRU:Called O to discuss UA findings. No UTI detected. Concerned about lower USG and protein in urine. Recommended GHP to assess kidney values. Offered O afternoon appointment but declined. Will r/v on MondayWill consider conservative management after this. - USMI drugs or pain relief trial —Plan: Booked in for GHP on Monday evening. Assess kidney levels. Could also do a UPC. If unremarkable consider starting propalin for USMI +/- stilboestrol Can also consider a pain relief trial- gabapentin Vs meloxicam to see if this helps her mobility to help her get up to go to toilet.  ________________________    Vital Signs    Weight: 8.9;