C09972032 / invoice 10000

1. Pet Primary Diagnosis / Suspected Diagnosis: ear pruritus 2. Suspected Cause: otitis externa 3. Other Conditions Being Treated (if known): anxiety4. Known health concerns: IBD 5. Date of first clinical signs (if known): Feb 2026Reason: Sedated ear cytology and examinationHistory: Ongoing ear pruritus, did not tolerate conscious examDue for C5 vaccination next month - O elected to vaccinate today under sedation Last in-house bloodwork performed Aug 2025, wnl. O declined repeat bloodwork today. Treatment: Sedated with 0.3mg/kg butorphanol 10mg/ml + 20mcg/kg medetomidine 1mg/ml IM - injected with minimal restraint, sat in front of nurse with another nurse scratching body, rolled onto his back for pats. Wriggled at end of injection and bent needle, good for second injection for rest of injection. 1mg/kg maropitant 10mg/ml SCSedation complications: NILOtoscope exam: both ear canals NAD with mild cerumin adhered to horizontal canal wall, no erythema or ulceration, no FBs. TMs intact. L ear cytology: Debris onlyR ear cytology: Debris only Protech Duramune C4 SCBatch #:Expriy:Protech BB SC Batch #:Expriy:Reversed with 0.43ml Atipamazole 1mg/ml IM Assessment:No evidence of OE. Pruritus likely secondary to body/skin pruritusFit for vaccinationPlan:Continue monitoring ear pruritus. Can continue apoquel 8mg PO SID for another few days until pruritus completely stops, then use PRN for future pruritus flare ups. Duramune C4 due in 3 years Pi2 and bronchiceptica due in 12 months--- 02/03/2026 10:44:47 CR:Bill checked    Vital Signs    MMColour: Pink;       Temperature: 39.2;       BodyScore: 5;       CRT: < 2 sec;       

Reason: Recheck Ears Possible Admit Appointment Notes: Overdue reminders1. Pet Primary Diagnosis / Suspected Diagnosis: ear pruritus 2. Suspected Cause: otitis externa 3. Other Conditions Being Treated (if known): anxiety4. Known health concerns: IBD 5. Date of first clinical signs (if known): Feb 2026History:Previous/existing medical conditions: Anxiety, separation anxiety, destructive behaviour, IBDCurrent medications: Cabalazorb daily (retesting at Sash showed still needed), Probiotic, Traz PRN, Gaba PRN. Anxiolytics for vet visit: clonidine 600mcg + trazodone 200mg + gabapentin 600mg FTW: Simparica Trio MonthlyVaccinations: Due 14/04/26Diet: Soft food with water and kibble - tablets mixed in with this. Royal Canin Anallergenic dry food.Fasted this morning. Gave all tablets in small amount of food but Max only ate a small amount, usually gives tablets in a full meal. Scratching ears and skin much less since finishing apoquel course. Still scratching ears occasionally. O reports a red rash on belly after walks sometimesNo other concerns EDDU normal, no V+D+ Examination:Temperament/Demeanor: BAR, friendly when approached in car. O using kibble to distract Max but unable to restrain him, becoming more reactive and wriggly with attempts to examine and swab ears. Oral: Nad Eyes/ears/nose/throat: No erythema or stenosis of ears. Shallow swab of RHS ear showed mild ceruminous dischargeAbdo palp: Nad Skin/coat: Nad, no erythema or lesions. Fur under chest harness very sparse and pink, no lesions Gait: Nad Assessment:Ongoing ear pruritus - ddx OE or skin pruritus secondary to allergic skin disease (atopy, food allergy, contact allergy) vs otherUnable to perform ear exam or cytology due to reactivity to restraint. No anxiolytics administered today. Plan: Recommended either reattempt examination another day with oral anxiolytics given with food and sileo gel vs admit today for parenternal sedation. O elected admission for parenteral sedation. Treatment plan given? Y Line billed? Y    Vital Signs    BodyScore: 5;