C09973467 / invoice 10000
Species:CANINE
Breed:Labrador Retriever
Age (years):12
Diagnosis or signs:Revisit
Consult notes
<html><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><p>Verified: yes</p> <p>Client: Daniel</p> <p>History: Presented for ongoing assessment of neurological signs. O reports dog walking better and more comfortable compared to last week. Hind legs still giving grief towards night after big/long day. Exercise - resting- backed off walking. Head tilt present. Improvement in gait noted since last visit. No circling observed. Mental status - still switched on, performing normal habits at home. No vision changes noted by O. Eating well. Past history of compulsive licking 5 years ago - not progressed, still present. Dog has been very healthy overall. O concerned re progression and management options. On 4Cyte for joints </p> <p>Exam:<br>Mentation: Bright, alert, switched on<br><br>Eyes: LEFT eye STrabismus - pointing downwards direction. PLR normal, normal oculocephalic reflex, normal vision, normal palpaebral, eyes retropulse normally<br>Ears: Not inflamed externally, minimal debris noted, checked again no signs of infection<br>Other oral exam:<br>MM/CRT: pink/moist, CRT<2s<br>Musculoskeletal: Walkign better than last time, standing more normally, less ataxia and previously with wide based stance and leaning on wall now able to walk straight.<br>Lymph Nodes: WNL <br>Neurologic: Head tilt present, Left strabismus, no circling, no nystagmus, pupils symmetrical and reactive, mild improvement in gait, hind leg ataxia/weakness, no seizures<br><br></p> <p>Assessment:<br>Head tilt, Left eye strabismus, hind leg ataxia/weakness, improved since last visit<br>: Vestibular signs ongoing, mild improvement<br><span style="color: #626262; background-color: #ffffff;">DDx</span>Ongoing Geriatric vestibular syndrome, brain lesion (neoplasia - benign or malignant, stroke), middle ear disease (less likely)</p> <p>Plan:<br>Options<br>continue monitoring there has been some improvement and he is well in himself<br>vs MRi/ CT brain to check for lesions <br><br>Daniel thinks will prefer to monitor for now. advised sometimes can have permanent head tilt but as long as walking improves. </p> <p>Recommendations & Client Comms: Continue monitoring at home for progression or deterioration of neurological signs. O works from home and able to monitor closely. Watch for increased stumbling, worsening ataxia, circling, changes in mentation, seizures, loss of appetite. Geriatric vestibular syndrome can take several weeks to resolve and dogs may retain mild head tilt permanently. Some older dogs have single neurological episodes (stroke, small tumour, benign vestibular syndrome) and stabilize without full recovery. Current presentation mild and stable/improving. Pain relief or anti-inflammatory medication available if required. Long course antibiotics (6+ weeks) discussed but not indicated - no evidence external ear infection, ear drums intact making middle ear infection less likely and difficult to treat/diagnose. Brain scan would provide diagnosis but unlikely to change management given age and stable presentation. Continue 4Cyte for joint support. Can have loxicom if wishes for OA - phone to pick up if requried. </p> <p>Recheck: Yes - PRN if deterioration or progression of signs, otherwise continue home monitoring</p></html>
Animal clinical history (3 most recent)
2026-02-19T00:00:00Z 09:15:00
Verified: yesClient:AmandaHistory: Compulsive licking 5 years ago with neurological concerns flagged at that time,. Now with 5 day hx of head tilt to the LEFT and falling over/ leaning when walking. eating well, no nausea, wants to go for walksExam:Mentation: BARWide based stance with back legs, head tilted to left, stanidning stifflyNo NystagmusNo hypersalivationLEFT ear - TM visible but msotly obscured by clump hair and wax. Right ear TM ntact also clump hair in front of TM but more visibleCytology of the wax in Left canal - no bacteria, occasional yeastTemp: 38C Cardio: HR =80, Resp: RR = 20Teeth: Gde 1/4,MM/CRT: pink/moist, CRT<2sAbdomen: NADSkin & Haircoat: NADNeurologic: Mild vestibular signsAssessment:Mild vestibular signsDDx: idiopathic Geriatric Vestibular syndrome, brain lesion/tumour, otitis internaPlan: No evidenceof rear infection externally, does not rule out internal infection, but less likely.Treatment:- Vivitonin 1.5 tablets BID PO for 10 days- Cerenia 160mg HALF SID x 4 days as a trial can have more if seems to helpRecommendations & Client Comms: Rest, supprtive care and nursing at home, monitor for improvement in symptoms, nausea treatment available if needed, if no improvement consider brain MRIRecheck: Yes, in 7-10 days to assess progress. If no improvement, discuss further diagnostics (brain scan) or empirical antibiotic trial20/2 - Doing ok, had vomitted when he got home out of the car but nothing since. O happy to cont as discussed with the vet nd call if any questions mc
2025-11-25T00:00:00Z 11:36:00
Verified:YESDANIELHISTORYPresenting for: 11-year-old male Labrador presenting for annual examinationHistorical Conditions: - Previously overweight, has lost weight since last visit- Appetite normalCurrent Meds:- Joint supplementLifestyle Risk Factors:- Regular walks, though not dailyOther:- Owner reports some stiffness/difficulty getting up at timesEXAMMentation: BARWt: 43 kg (reduced from previous visit)BCS: Improved, waist visibleMusculoskeletal: SORE L HIP TO FULLY ERXTEND. RIGHT HIP REDUCED extension. stifles normaleyes - early nuclear sclerosisnormal abdo aplplipoma left neck checked at last visit.normal lymph nodesears, sin and coat nadASSESSMENTAge-related joint stiffness - Early arthritis changes typical of large breed senior dogOtherwise apparently healthyTX - canigen vacc sc, excellent for injPLANNew Meds/Tx:- Recommended 4Cyte joint supplement (contains glucosamine and additional extracts) to replace current joint supplementClient Comms:- Patient will be pre-booked for annual examination in 12 months26/11 - NCB no answer mc
2025-05-21T00:00:00Z 11:59:00
Presented for mass checkClinically wellNoticed a lump "suddenly" show up on the left side of his neck. Not irritated by itNo v/c/dEDDU - normalBAR, Pink MMs, CRT < 2secHeart and chest clear on auscMSK - WNLs3cm x 3cm mass Lateral neckMoveable, non attached ScSuspect lipoma, however extra material seen on slide (artifact from stain vs pathology/mast cell etc).Send to vetscan for analysisCall owner with results22/05 NCB no call required, NL will call with resultsResults - Adipose tissue only - lipomaCalled Amanda with results
Previous claim history (4)
| Date | Claim # | Diagnosis |
|---|---|---|
| 2026-02-19 | C09924260 | VESTIBULAR DISEASE |
| 2017-06-06 | C1223036 | EAR INFECTION |
| 2016-12-28 | C1064829 | HOT SPOT |
| 2014-12-31 | C0447377 | LAMENESS RF |
Line items(lines with upstream diagnosis are skipped by the model)
| Line | tstarc | Amount | Date | Upstream diagnosis |
|---|---|---|---|---|
| 10000 | tstarc_consultation-revisit | 113.95 | 2026-03-02 | — |
UPM+
- DG01928VESTIBULAR DISEASEDSTP_vestibular_disorder
Variant (sleepy_king)
VESTIBULAR DISEASE
DSTP_vestibular_disorder
Conf: 0.990
Threshold: 0.90
Above: ✓
Correct?