C09971895 / invoice 10000

Reason: Vacc Recheck - Awating VSS Results Appointment Notes: CRHistory: Max is presenting for his annual vaccination and recheck of ongoing issues.Recheck of lethargy, inappetence and difficulty prehending food. This started after a general anaesthetic and ear flush for recurrent otitis externa. He has been seen at VSS, where an abdominal ultrasound and bloods were performed, which were normal. Awaiting results of a swallow study. Owner concerned about potential nerve damage from anaesthetic.EDDU normally, no V+ or D+, coughing or sneezing.Diet: RC dry food, sometimes soaked. Also given boiled chicken, mince, or roast chicken with sweet potato. Preventatives: UTD NGS. Behaviour: FAS score (0-5) - 2-3, O muzzles for exam and holds well Medical hx: Previous otitis externa, managed with anaesthetic ear flush and steroids (course now finished). Allergic skin disease managed with Cytopoint. History of diarrhoea with meloxicam in July 2024 for limping. Pre-anaesthetic bloods showed a mild elevation in a liver enzyme. Medications: - Cytopoint 50mg given 6 weeks ago - Neptra instilled 4 weeks ago Examination:BAR, BCS 6/9Eyes: clean and clearEars: Both ears contain some debris, no significant infection seen on cytology (cells and debris only).Thoracic: normal BV sounds, no murmur auscultated, fem pulses strong & synchronousAbdo: soft and comfortableMSK: ambulating all four limbsNeuro: appropriate mentationInteg: WNLLNs: all WNLRectal: not performed todayAssessment:Fit for vaccinationOngoing issues awaiting review with VSSPlan:Vacc today with BBPi inj. Due again in 1yr (reminder set). Discuss adverse events such as lethargy, allergic reaction. Though rare, represent if concerned.Will contact VSS today to follow up on swallow study results and discuss next steps if results are normal. Advanced imaging (CT/MRI of the head) may be required.CLIENT COMMUNICATION:Discussed that Max is up to date with his kennel cough vaccination. Advised that cytology of the ears showed no infection, just debris. Informed owner that I will be contacting VSS to follow up on the results of the swallow study and to discuss the next steps in his diagnostic work-up as this has been uncl;ear with owner. I'm also not sure why US was performed? An email will be sent to the owner (papasgeorge@hotmail.com) with an update.    Vital Signs