C09977292 / invoice 10000

Reviewer

Species:CANINE

Breed:Maltese

Age (years):9

Diagnosis or signs:Consultation notes

Consult notes

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<p><strong>Itching ears and licking paws <br><br>HISTORY:<br></strong>In today for itchy skin - licking paws and itching ears<br>Owner unable to pluck ears - gets very stress<br>Also suffers from airway dz (collapsing trachea). Doing really well with current medications (Flixotide 1 puff BID and Lomitol 1.25mg SID) <strong><br></strong><br>No other concerns for today <br>UTD with px care <br><br><strong>EXAMINATION</strong>:<br>MM: Pink and moist <br>CRT &lt; 2 second<br>Demeanour: BAR<br>Hydration: Euhydrated <br>Cardiovascular: Dual heart sounds auscultated, no murmur or arrhythmia detected, SSFP<br>Respiratory: Normal bronchovesicular sounds bilaterally, normal effort<br>Neurological: Appropriate &amp; normal mentation, gait and posture<br>Musculoskeletal exam: Good BCS and normal ambulation <br>Gastrointestinal: Comfortable on abdominal palpation <br>Genito /Urinary: Bladder palpates WNL<br>Integument: pododermatitis. Eythema of interdigital skin, but no ulceration or excoriation of skin. And no saliva staining <br>Eyes: Difficult to visualise on Otoscopic exam due to thick tufts of hair. Has lot of yellowish ceruminous discharge clumped in hair. Smells yeasty <br>Ears: Normal, no auricular discharge bilaterally<br>Mouth: Dental grade 1/4<br>Lymph Nodes: Submandibular, prescapular and popliteal palpate normally<br><br><strong>LAB</strong>:<br>Ear smear and diff quik stain<br>- Malasezzia +++<br><br><strong>ASSESSMENT</strong>:<br>Allergies/atopy with secondary otitis externa - yeast<br><br><strong>TREATMENT</strong>:<br>Cytopoint 10mg by sq injeciton <br>Dermotic 0.5ml BID for 7 days<br>Ears plucked <br><br><strong>PLAN:</strong><br>Home with Cortavance spray to apply to paws SID as required.<br>Repeat Cytopoint in 4 wks <br><br><br><br>.</p>
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Animal clinical history (3 most recent)

2025-11-13T00:00:00Z 09:11:00

KC vac HISTORY:Recently been to see Josh King for check-up (for mgt of airway dz). Currently on Steroid puffer and Lomitol and doing really well EDUF all normal. UTD with px care Simparica Trio EXAMINATION:Hydration: EuhydratedCardiovascular: NAD - Normal heart sounds, no murmur identifiedRespiratory: NAD - Normal bronchovesicular sounds with no crackles/wheezesNeurological: NAD Musculoskeletal: NAD Gastrointestinal: NAD Genito /Urinary: NADIntegument: NAD Eyes: RIGHT: NAD LEFT: NADEars: RIGHT: NAD LEFT: NAD Mouth: NADTeeth: light tartar only Occlusion: NADLymph Nodes: NADASSESSMENT:Fit for vac TREATMENT:PI2 5264017 exp 06.01.2027 and Protech Bronchi-shield Oral 5245045B exp 19.11.2026

2025-08-27T00:00:00Z 09:51:00

Revisit for coughingHISTORY:Still coughing alot - no significant improvement. Mostly happens when when gets excited or goes for walks -> owner showed a short video that demonstrates Darcy making a snorting type noise (sounds like reverse sneeze) Currently on Redipred liquid 0.2ml in the am (~ 4-5 times per week) and Neulin 1/4 of a tablet at night UTD with px care EXAMINATION:Lovely little dogMM: Pink and moistCRT < 2 secondDemeanour: BARHydration: EuhydratedCardiovascular: Dual heart sounds auscultated, no murmur or arrhythmia detected, SSFPRespiratory: Normal bronchovesicular sounds bilaterally, normal effort. Upper resp tract sounds quite wheezy - with increased effort on inspiration. Very reactive - honking cough elicited with very light pressure (stethoscope diaphragm only)  No nasal or ocular discharge Neurological: Appropriate & normal mentation, gait and postureMusculoskeletal exam: Good BCS and normal ambulation Gastrointestinal: Comfortable on abdominal palpationGenito /Urinary: Bladder palpates WNLIntegument: Good coat condition, no ectoparasites visualisedEyes: Symmetrical, no ocular discharge or blepharospasmEars: both ears look nice and clean - NAD Mouth: Dental grade 2/4. Moderate tartar and gingivitis Lymph Nodes: Submandibular, prescapular and popliteal palpate normallyPROBLEM LIST:Intermittent coughing and reverse sneezingCollapsing trachea (mild) Everted laryngeal saccules (mild/mod)Grade 2 dental score ASSESSMENT:Dx Glottal spasm and cough result of everting saccules and collapsing tracheaAlso suspect concurrent rhinitis or irritation to nasopharxyn (reverse sneezing). TREATMENT:Home with Redipred - to give 0.1ml BID for 3-5 days, then SID for maintenanceNeulin 50mg SID Iramine 4mg BIDPLAN:Strongly recommend referral to Internal Medicine Specialist for ongoing mgt and potential airway surgery

2025-06-10T00:00:00Z 12:11:00

redipred seems to improved with cough 80% improvement.AT STOResponsed really well to the Redipred. Coughing is signigficantly reduced.Ok to dispense another bottle, but recommend try reducing the dose to 0.25mg/kg (0.2ml).If coughing not controled at the lower dose then ok to go back upto 0.5mg/kg SID (0.4ml), however strongly recommend trialing on Fluticasone for reduced side effects long term

Previous claim history (6)

Date	Claim #	Diagnosis
2026-01-20	C09783404	TRACHEAL COLLAPSE
2026-01-19	C09777777	TRACHEAL COLLAPSE
2025-12-26	C09678229	TRACHEAL COLLAPSE
2025-12-26	C09679795	TRACHEAL COLLAPSE
2025-12-24	C09673573	TRACHEAL COLLAPSE
2025-12-15	C09629330	COUGHING - PRESENTING COMPLAINT

Line items(lines with upstream diagnosis are skipped by the model)

Line	tstarc	Amount	Date	Upstream diagnosis
10000	tstarc_consultation	97.00	2026-03-03	—
20000	tstarc_diagnostic_test_-_cytology	71.00	2026-03-03	—
30000	tstarc_skin_medication_-_cytopoint	173.73	2026-03-03	—
40000	tstarc_ear_medication_-_antibacterial_and_anti-fungal	38.41	2026-03-03	—
50000	tstarc_skin_medication_-_cortavance	63.44	2026-03-03	—

UPM+

DG02323HYPERSENSITIVITY (ALLERGIC) SKIN DISORDER - ATOPIC DERMATITISDSTP_skin_-_allergic_disorder

Variant (sleepy_king)

HYPERSENSITIVITY DISORDER (ALLERGY)

DSTP_skin_-_allergic_disorder

Conf: 0.370

Threshold: 0.38

Above: ✗

Correct?

Yes No