C09976689 / invoice 10000

Reason: HC + Plan For Asp. Pnemonia See HxAppointment Notes: ------- Sms reply: YHISTORY:See attached Hx for extensive aspiration pneumonia management.Summary of history:- Lifelong frequent episodes of aspiration pneumonia normally induced by vomiting or regurgitation. Managed either at their GP if mild, or will see BVECCS if severe CSx/needing hospitalisation. Normally managed with 500mg amoxyclav BID for variable time periods +/- tapering steroids. Previously has also needed enro or doxy. Previously would get chest xrays done at each new episode, but now the CSx are so predictable for the Os that they prefer to treat based on symptoms unless new or different signs arise.- Multiple BOAS surgeries performed over the years to attempt to reduce the vomiting/regurg and pneumonia episodes- GI issues were more frequent in earlier years. CT, endoscopy and intestinal biopsies have not highlighted any cause for the GI signs, however there has been significant improvement with the use of Prime 100 croc (has been using Hills z/d recently due to inability to get croc rolls). Also using cisapride TID. Will use maropitant during active vomiting episodes.- chronic allergic skin disease with recurrent infections.Consultation for ongoing management of recurrent aspiration pneumonia and chronic skin issues. Os have recently moved to the area and would like to establish an ongoing plan and understanding for when he has an aspiration episode and needs medication. The owner is experienced in recognising the signs of aspiration. The most recent aspiration event occurred after a food change to the pea absed Prime 100, which led to vomiting and subsequent respiratory signs. He was taken to Petstock and then referred to BVECCS. The owner notes that Bruno often does not present with severe clinical signs initially after an aspiration event, which has previously led to delayed treatment. He has also been on a long course of an antifungal in the past which didn't really show any improvement (dose was 19mg/kg). Currently, respiratory signs are well-controlled. The owner reports a "yeasty" smell from the skin.Pre-existing conditions: Recurrent aspiration pneumonia, chronic skin disease (atopy, suspected secondary infections), Current meds:Apoquel daily for atopy.Pulmicort nebulised with saline once weekly.Cisapride TID.Maropitant (Cerenia) as needed for vomiting episodes.CBD oil dailyVaccination: Not mentionedParasite Prevention: Not mentionedExamination:BCS: 3/9Neurological:BAR, appropriate mentation. Cranial nerves appear normal. Full exam not performedMucus Membranes and Hydration: MM pink, moist, crt<2. Euhydrated.Rectal Temperature: Temperature not taken.Cardiovascular: HR 120, cardiac auscultation normal, no murmurs, normal rhythm.Respiratory:normal resp rate when not panting, thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge.LNs: normal size, NADDental grade/oral exam: C1G1Eyes: Full ocular exam not performed todayEars: no stenosis, erythema or discharge. Otoscopic exam not performed.Abdominal palpation: soft, no palpable masses/FB/organomegalySkin: yeast smell, large areas of erythema, alopecia and seborrhoea ventral neck, ventral abdomen, paws.Musculoskeletal: ambulating normally, Full exam not performedUrogenital: No swelling or discharge, NADDemeanour/Behaviour: Bright and alert.DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Recurrent aspiration pneumoniaChronic allergic dermatitis with secondary bacterial and yeast infectionsOA based on previous HxDIAGNOSTICS:Tape prep of skin: malassezia ++, cocci +ASSESSMENT:Bruno presented for a consultation to establish a relationship and an understanding about the ongoing management of his complex medical conditions, primarily recurrent aspiration pneumonia and chronic skin disease. On examination, his respiratory system is currently clear on auscultation. Skin cytology confirmed a mixed bacterial and yeast overgrowth, consistent with the owner's report of a yeasty odour. The current plan is to manage these conditions proactively.TREATMENT:Dispensed Terbinafine script. Start at 2 tablets once daily for one week, then increase to 3 tablets once daily if tolerated. To be given with food.Dispensed amoxyclav 500mg tablets to continue for another 2 weeks.Dispensed Prednisolone tablets for emergency use in case of aspiration based on previous doses.PLAN:Start Terbinafine for fungal skin infection.Owner to monitor for any adverse effects from new medication.Re-check consultation scheduled for 16/03/2026 to assess skin and overall progress. This will be with Dr. Angelika, who will be briefed on the case.Given extensive history and experience with his medical conditions, I am comfortable to provide ABs and pred as required when an episode occurs and Os to get in to see us ASAP when this occurs.    Vital Signs    Weight: 25.1;