C09971636 / invoice 10000

DATE/TIME of CONSULTATION: 12:00hrs, Sun 01/03/26
CLINICIAN: JG 

PRESENTING COMPLAINT: vestibular signs

HISTORY:
One prior episode of vestibular signs, presumed idiopathic vestibular disease. Improved after ~2w. 
Developed head tilt to RHS 2-3d ago. Ambulatory x4 but stumbling occasionally to RHS. Restless and occasionally circling to RHS. 
EDUD normally.  Remains bright and happy at home. 

History of OE. No recent scratching or irritation. 
Known cushings disease. On oral syrup  PO BID. 

CLINICAL FINDINGS: PROBLEM LIST:
DIFFERENTIALS:
OPTIONS PROVIDED:
DIAGNOSTIC TESTS:
DIAGNOSIS:
TREATMENT:
CLIENT COMMUNICATION/PLAN:

DATE/TIME of CONSULTATION: 20:12hrs, Sun 09/11/25
CLINICIAN: NS
PRESENTING COMPLAINT:Vestibular

HISTORY:
Head tilt to the R and a bit unbalanced. Has been a few days but not as bad. Now more consistent. Still eating and drinking, no vomiting or diarrhea. 
Known cushings disease. 
Always has ear infections but dont think he has one right now. Not been scratching or shaking head. 

Medications: liquid BID for cushings
Diet:dry food + roast chicken 

CLINICAL FINDINGS: 
Demeanour BAR, BCS 6/9, lovely dog. 
HR 120, no m/a, RR panting, MM pink <2s, moist, temp 38..2
Mild head tilt to the R. No nystagmus. Menace intact, palpebrals present. 
Ambulatory, very mildly wobbly. Abdomen comfortable on palpation. 
Ears grossly appear clear, no redness, some brown discharge. 

PROBLEM LIST:
- R head tilt ddx vestibular, infection, middle ear disease, neoplasia, stroke, other 

OPTIONS PROVIDED:
1/Conservative management
2/Bloods +/- advanced imaging
O elected option 1

DIAGNOSTIC TESTS:
*Ear cytology - no bacteria or yeast seen, lots of debris.

TREATMENT:
- Maropitant 1mg/kg SQ

CLIENT COMMUNICATION/PLAN:
- Ondansetron 8mg q12 PO PRN
- Consider bloods +/- imaging INI or deteriorates vs euthanasia 

Discussed possible ddx of head tilt. Discussed further investigation vs trial medications in case vestibular. Given age and clinically well, O elected to trial medications and will review INI. O unlikely to pursue advanced imaging, if quality of life affected, discussed euthanasia.