Bethany Family Pet Clinic

INVOICE

15166 NW Central Drive

Portland , OR 97229
503-614-9061

FOR:

Printed:
Date:
Account:
Invoice:

Stefanie Gunderson
6035 N. Curtis Ave
Portland, OR 97217

Date

For

Qty Description

Price

02-28-16 at 3:29p
02-28-16
9749
90793

Discount

Services by Leigh-Anne Lariviere

02-28-16
Hedwig
1 Physical Exam by DVM: Comprehe 49.50
24.75
Exam Findings
General appearance: QUIET, alert and responsive; good body condition,
hydrated; BCS = 3/5
Eyes: MILD NUCLEAR SCLEROSIS OU, otherwise within normal limits
Ears: No exudate observed; no redness present
Integument: Normal amount of shedding; skin looks normal; hair coat in good
condition; MODERATE FLEA DIRT, no fleas seen; THERE IS AN OBLONG 4cm
SOFT, FLUCTUANT, MOVEABLE NONPAINFUL SC MASS VENTRAL
ABDOMEN, not associated with a mammary gland, no herniation palpated
Oral Cavity: MM = pink/moist; MODERATE GINGIVITIS AND STAGE II
CALCULUS
Lymphatics: Lymph nodes all normal size
Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses;
CRT < 2 sec
Musculoskeletal: Ambulates normally
Gastrointestinal: Normal eliminations; palpates normally, supple and nonpainful
Urogential: Owner reports normal eliminations; external genitalia appears normal;
bladder palpates normally
Respiratory: Lungs ascultate clear; trachea clear, no muffled heart sounds; no
dyspnea even after handling
Neurologic: No apparent abnormalities
Pain assessment: Minimal pain
Other:

Net Price

24.75 **

02-28-16

1 Assessment
Possible diaphragmatic or peritoneopericardial diaphragmatic hernia
Hematemesis (related to possible hernia vs. GI vs. extra-GI disease)
Periodontal disease
Diabetes mellitus (treated with food currently)
Fleas
SC mass

0.00

02-28-16

1 Treatment Plan:
1. We took xrays of Hedwig today and found a possible hernia between her
thorax and abdomen, potentially involving the sac around her heart; I am sending
in these xrays to the radiologist for review and will call you tomorrow with these

0.00

results. If this is the case, this could contribute to her intermittent vomiting (even
the blood today) and intermittent breathing "episodes".
2. We are sending off lab work to check her overall metabolic and organ function,
clotting function and check her for pancreatitis. I should have these results back
tomorrow as well.
3. We have treated her symptomatically at this time for the vomiting; I
administered fluids under your pet's skin today. This will assist with hydration. She
will need to urinate more than normal over the next 12-24 hours. I have also given
her an injection of Pepcid AC (famotidine) due to the blood in the vomit.
4. I am sending home Sucralfate with her. This is a medication used to coat the
stomach and upper small intestine in case of GI ulceration. Please start this
ASAP and give until gone.
5. If Hedwig does have a hernia, I recommend referral to a boarded surgeon for
surgical reduction and correction. I will call around tomorrow and try to get a
general estimate for this so that we can be planning for it.
6. It is possible that Hedwig has had this abnormality for a long time; it is
impossible know when or if it is going to cause her a problem in the future. Please
monitor her for any continued vomiting but also any breathing problems. If she
starts to have breathing problems or continued vomiting of blood, I recommend
that she be seen by a veterinarian immediately.
7. Her blood glucose today was higher than reported by your previous
veterinarian. It is possible that this is just due to stress, but it could be that her
diabetes is progressing. I ideally I would have collected a urine sample from
Hedwig today to check for ketones in the urine, but because of her history of not
responding to the cystocentesis well, I was fearful to do this today. I have sent
home with you some No-sorb, a non-absorbent kitty litter. Please put her in a
room by herself with her own litter box and the No-Sorb. When she urinates you
can collect it into a small, clean, dry container and drop it off at the clinic so that
we can run a urine dipstick on it screen for the ketones.
8. At some point, Hedwig may need to be started on insulin for her diabetes.
9. Hedwig has evidence of fleas; I recommend flea prevention every month of the
year even for indoor cats.
10. I do not know what the mass is on her ventral abdomen without doing a
biopsy of it, but based on the xrays it is not a hernia.
11. Hedwig was a great patient today -- we hope that she feels better soon!
Please call with any problems or questions!
02-28-16

1 Blood Glucose Test (Glucometer)

19.25

19.25

0.00 **

BG at 11:10am 338
02-28-16

1 Radiology, Up to 3 views
full body rads, 3 views: moderately distended urinary bladder, no obvious FB
noted; there is marked lack of definition in the caudal thorax, cannot discern
diaphragm, possible liver and gas around heart -- suspect hernia; cannot evaluate

165.50

cardiac silhouette, no obvious pleural effusion, cannot locate liver and stomach in
cranial abdomen
02-28-16
02-28-16
02-28-16

1 Pre-Op Profile
1 Spec fPL - Feline ADD-ON
1 Lactated Ringers Solution given SQ

72.50
36.50
32.25

0.23 Famotidine 10 mg/ml Injection (Pep

19.76

LRS 100mls SC
02-28-16
SC
02-28-16
02-28-16
02-28-16

1 Nosorb Litter, 4 oz.

5.50
5.50
1 Radiograph Review by Radiologist
11 Sucralfate 1 gram Tablet
Dissolve 1/2 tab in about 3mls of water and give orally every 8-12 hours; if this
does not work you could crush it and sprinkle it in a small amount of canned food
but she should eat it all at one time

0.00 **
91.50
18.40

Services by
02-28-16

#2V2

Old balance
0.00

Visa payment
Charges
461.16

Patient
Hedwig

Payments
461.16

-461.16

Discount
49.50 **

New balance
0.00

Total charges
461.16

Reminders for: Hedwig (Weight: 10.3 lbs - 10y)

02-27-17
01-29-16

Annual Exam
Purevax Rabies Vaccine 3 Year

Last done
02-28-16
01-29-13

Hedwig's weight history (in lbs)

02-28-16

10.25

We are now open Sundays from 8:00a-3:00p to help with all of your pets health care
needs.