C10034299 / invoice 10000

History: See previous visits - persistant increase in ALT found incidentally on PAS Diagnostic Imaging: CG performed abdo US - no abnormalities seen, report pendingLaboratory: Blood taken2tbsp maintenance food fedBlood taken again 2 hours laterClient Communication: AO tried to call to get consent for idexx liver panel add on as per CG recommendation ($230) as ideally would get a number using a dilution method in case is a false readingPlan: Await reportAwait idexx bile acids Await liver panel    Vital Signs    Weight: 11;       

Reason: Recheck Bloods - Level 1aAppointment Notes: Overdue reminders  ------- Sms reply: YHistory: Well at homeEDDU all normalNo V/D/C/DUTD with flea/tick/wormingNo concerns Laboratory:ALT >1100AST 155Cholesterol:10.52Phone call:Points Discussed:Juno's recent blood test results show progressive liver changes  . A previously elevated liver enzyme remains high, and a second liver enzyme is now significantly elevated, at approximately triple the upper reference limit.(ALT >1100, AST 155)The need for further investigation into the cause of the elevated liver enzymes (hepatopathy).Decisions Made:The owner has consented to proceed with further diagnostic testing as recommended.Next Steps:Book Juno for a specialist abdominal ultrasound with the travelling ultrasonographer at the Campbelltown clinic.A bile acid stimulation test will be performed on the same day as the ultrasound. Juno will need to be fasted for this procedure.Juno will be admitted to the clinic for at least half a day for these procedures.An appointment will be organised for the next available time this week.The estimated cost for the procedures is just over $1,000.The owner was advised to monitor Juno for any signs of illness, such as vomiting, inappetence, or increased lethargy, and to contact the clinic if any concerns arise.--- 21/01/2026 10:54:03 ELR:Emailed SVUS for ultrasound dates--- 21/01/2026 10:59:52 ELR:SVUS can do next Tuesday - called Megan, no answer - left vm.--- 21/01/2026 14:01:51 ELR:Confirmed with SVUS + Megan for next Tuesday. Consent to send history given verbally.--- 21/01/2026 14:19:04 ELR:History emailed.    Vital Signs    

Reason: Stage 1 Dental + BloodsAppointment Notes: Overdue reminders  ------- Sms reply: YHistory: Stage 1 dental PAS yesCPR yes FastedQuite anxious girl Examination: BAR very fearful and anxiousEENT NADLNs WNLOral  mild calculus Abdo palp tenseGait NADChest ausc NADTreatment: 75mg trazodone PO on admission due to high anxiety Anaesthesia: Premed: meth (0.4) 0.4ml + dexd (10) 0.2ml IM CCV Laboratory: PAS ALT >1100Rest of PAS WNLCBC initially seemed anaemic but wrong CBC was looked atCorrect one was run - mild neutrophilia, no other abnormalities Assessment: Ideally postpone dentalClient Communication:CCV contacted Megan regarding Juno's scheduled dental procedure which was cancelled due to abnormal pre-anaesthetic blood work results. One liver enzyme (indicating hepatocellular damage - ALT) was elevated approximately 10 times normal range, whilst bile flow enzyme (ALP) remained WNL. CCV explained the elevated enzyme suggests liver cell damage with enzyme release into bloodstream, potentially due to reactive hepatitis from ingested toxin, hepatic abscess, infection, or liver other disease.CCV advised recheck PAS in 2 weeks including liver enzymes, CBC, and urinalysis. If values remain elevated or fail to decrease significantly, SVUS ultrasound at Campbelltown clinic would be organised + bile acids. WBC count also noted to be elevated suggesting possible inflammatory or infectious process. Anaemia suspected by machine but manual recheck indicated normal values.Megan confirmed Juno not on any medications and could not identify any potential toxin exposure. CCV explained dental procedure was prophylactic rather than urgent due to pain, making risk-benefit analysis favour postponement. Discussed that blood work provides snapshot of current liver cell damage but doesn't indicate functional capacity or structural extent of injury.CCV administered trazodone for anxiety during hospital visit with good response. Dispensed 9.5 tablets remaining for future vet visits - half tablet night before and morning of appointments. Advised monitoring eating, drinking, and general behaviour for any changes. Instructed collection of morning urine sample if possible using container during walk for recheck appointment.Discharge arranged for 5:30 PM same day. CCV emphasised importance of investigating elevated liver values before proceeding with elective anaesthetic procedure despite Juno appearing clinically well on physical examination.Treatment: Antipam 0.2ml IM Plan:Rpt PAS + morning inhouse UA in 2 weeks Give traz prior to appt If ALT persists or improvement inadequate next step SVUS US + bile acids Rebook dental once liver investigatedRJ told O correct CBC results--- 08/01/2026 08:08:48 JRA:Follow up txt sent as just sedation yesterday, did not proceed with dental due to blood results (see above notes).Hi, she was tired and lethargic last night but seemingly back to normal this morning, ate a big breakfast ??    Vital Signs    Weight: 10.89;       HeartRate: 140;       DentalGrade: 1/4;       RespirationRate: pant;       CRT: <2;       MMColour: p+m;       BodyScore: 3/5;