C09971572 / invoice 10000

Reason: Initial - Surgery ReferralMedicine referral summaryReason:History:Bonnie is referred from the surgery service following a consultation for anal sacculectomy. Has chronically full anal sacs requiring expression every 2 weeks - with normal secretions, easily expressed. However, diarrhea with blood reported so recommended review of this prior to considering surgery. Has had some diet trials in the past and has been on supplements, including psyllium and pre/probiotics.  February 2026: Metronidazole treatment trial Owner reported history: Has had GI signs since she was a puppy. BIOP since 8 wo. Severe diarrhoea as a puppy and tested positive for canine coronavirus.Defecation: Large intestinal signs - straining, blood. Score usually a 4-5, occasionally a 6-7. Mucus and blood noted occasionally (5-10% of the time). 1-2 defecations a day but usually associated with straining. Vomiting: Occasional true vomiting, occurs maybe every couple of months Regurgitation: Every 10 days or so, sometimes when running around with a toy in her mouth, sometimes after drinking Scooting is a problem regularly along with spontaneous release of the anal sacs Appetite is good Weight is stable Energy levels are good Respiratory: Good - no exercise intolerance or stertor/stridor when awake. Snoring when asleep occasionallyOwner wonders if anxiety makes diarrhoea worse, as sometimes symptoms appear worse when owner is away. Recent diagnostics December 2025CBC: HCT 0.61Biochem: WNL, ALB 35T4: 23 Has had saliva allergy testing done: reactions to chicken, corn, milk, pork, turkey, white fish and venison Current diet: Raw beef mince + prime 100 beef dry + single protein duckCurrent medications: - Psyllium 3/4 of a TSP in the morning - started 8-9 days ago Diets trialled: - RC anallergenic; worse regurgitations- Prime 100 crocodile - Prime 100 kangaroo - Prime 100 turkey - Big dog raw goat - didnt like it Hasn't tried: - Duck exclusively - Prime 100 pea and algae - Soy protein based diet Previous supplements:- Gut restore - Beef pancreas - For anxiety Parasite prevention: - Nexgard spectra Previous medical history- 2-3mm raised scabbed pink lump on LHS vulva - Recurrent otitis; management with MVSC - BOAS - nares, soft palate, tonsillectomy- Regurgutation or vomiting reported in October 2023, undergoing anallergenic diet trial at this time - MLP Physical examination:Demeanour - Bright and alertVital signs - MM pink, CRT<2s, HR  bpm, RR  bpm, T  CCardiovascular - Cardiac auscultation normal, pulses strong and synchronousRespiratory - Effort normal, bronchovesicular sounds audible all quadrantsAbdomen - No abnormalities on palpationHead / neck - No abnormalities identifiedMusculoskeletal - Normal gait, no pain identifiedIntegumentary - No abnormalities identifiedGenitourinary - No abnormalities identifiedLymph nodes - Peripheral lymphadenopathy not detectedBCS  /9. Body weight  kg.Procedures:Premed - Anaesthesia - Laboratory:Haematology -Biochemistry - Urinalysis - Imaging:Assessment:Treatment:Plan:Client communication:Vet communication:    Vital Signs    

Reason: Initial - Anal Gland RemovalAppointment Notes: Hx req 23/01SURGERY INITIAL CONSULTSPresenting complaint:Referral for consideration of anal sacculectomy for chronically full anal glands.History:History of persistently soft stools and sensitive stomach since a puppy, despite various diet trials and probiotics. Requires manual expression of anal glands approximately every two weeks. Glands are reported as full but express easily with normal secretions, never impacted or infected. Scooting behaviour is frequent. Recent episodes of colitis with haematochezia and tenesmus, described as "mustard chutney" consistency. Previous treatment with metronidazole for colitis was administered.History of chronic otitis, now well-managed with a topical steroid ear cleaner every 2-3 days following an ear flush procedure at MVSC. Ear drums were intact on examination. Previous brachycephalic obstructive airway syndrome (BOAS) surgery performed.A microbiome test was recently performed; results are pending. Supplements have been ceased pending results.Physical examination findings:General exam: Bright, alert, and responsive. Breathing comfortably. Abdomen soft and non-painful on palpation. HR=120 RR=12. Thoracic auscultation normal. Abdominal palpation normalRectal exam: Anal sacs palpated. Anal glands empty..Medications:Topical steroid ear cleaner every 2-3 days.Assessment:Chronic anal sac filling secondary to persistent soft stools and failure of normal emptying mechanisms.Chronic intermittent colitis/enteropathy.Suspected inflammatory bowel disease (IBD) given breed, chronic gastrointestinal signs, and history of atopy (chronic otitis).Plan:Anal sacculectomy is not recommended at this stage. The primary issue is likely gastrointestinal disease leading to poor stool quality and secondary failure of anal sac emptying. Surgery carries significant risks, including infection, wound dehiscence, post-operative straining, and permanent faecal incontinence (risk up to 5%).The priority is to achieve a diagnosis and control the chronic diarrhoea.Referred to the internal medicine service for investigation of chronic diarrhoea. A consultation has been scheduled with Dr Susan Ciaravolo for 24/02/2026 at 9:30 AM.Discussed that the internal medicine team will likely manage this as a case of chronic diarrhoea, which may involvediagnostics such as intestinal biopsies (via endoscopy or surgery) to diagnose conditions like IBD, and potentially immunosuppressive medications.Comments:No charge for today's consultation.    Vital Signs