C09979454 / invoice 10000

03/03/2026 Check ears 
Owners unable to give PVP today
BAR
Very lovely but panics when restrained. 
Drew up 0.4 torb and 0.2 medetomidine but some did not get injected. 
Sedation fine for exam of ears
Full Ga required for ear clean 

History:
Duration: 
previous ear flush on 16th Jan, 
2th Feb 24 - sore ear 
27th Sept 23 - ear infection

Diagnosis/symptoms: Has been ok at home not exhibiting pain/ irritation of the ears, owners unable to look at ears or treat at home
Unable to examine ears in consult. 


Pre-Anaesthetic Examination:
Temp: Not taken
Cardiovascular (BP, ECG, SPO2 for unwell patients): 120
Respiratory: 20
Abdomen: soft

Anaesthetic Report:
See above
Quality of sedation: profound

Catheter (size/location): RF

Induction:
(1-2)mg/kg alfaxalone titrated to effect = 1.5mls IV

ET tube:          8                                                        Circuit: Baine
Fluids: yes
Eye Lubrication:yes

Maintenance: Isoflurane 2% and Oxygen  2L/min
Duration:  30 minutes 

Details of anaesthetic (note any complications, interventions required etc):


Procedure: 
Empty anal glands - full

Ear clean saline and epi optic, inflamed
Thick black material adherent to distal canal obscuring TM
Cleaned and flushed
Bleeding

Swabs show cocci ++, malasezzia 1+

Consider allergic skin disease underlying - feet and rest of body ok
Rec food elim trial fish and rice next 8 weeks minimum 
Had many GI upsets as puppy
On chicken and kibble now plus lots of human food

Plan: 
Neptra applied both ears
Start pred and DC fish and rice

Recheck for sedation/ GA in one month plus dental prophy grade 2 (will do estimate for this) 

Called and spoke to Maddie
Call made by: Luci 
Spoke with: Maddie 
Reason: Post-anaesthetic bilateral ear infection update
Summary:
- Ears significantly improved since last anaesthetic cleaning but not fully resolved
- Reduced bacterial load and cocci present, but inflammation persists
- Ears remain painful to touch
- One month ear treatment administered during procedure
- Anti-inflammatory tablets prescribed
- Anal glands expressed - were quite full, owner unaware of scooting
- Dental disease noted with tartar buildup
- Recommending hypoallergenic diet trial (delicate care skin or stomach) for potential food allergy
- Common allergens include chicken, beef, lamb, and soy
- Diet trial should be exclusive for 8 wks after gradual introduction
- Patient recovered well from anaesthesia
- Owner mentioned having similar allergies to their dog
Summary:
- Plan sedation in one month to reassess ears and consider dental scale and polish
- Pickup time approximately 3pm or earlier if ready
- Monitor diet transition and consider appetite stimulants if needed
- Veggie dental treats recommended as hypoallergenic option

Action items:
- Call owner if patient ready for pickup before 3pm
- Schedule follow-up sedation in one month for ear check and potential dental procedure
- Provide veggie dental treats as hypoallergenic option Got some previously but she did not like them). 

Call made by: Luci
Spoke with: Greg
Reason: Post-anaesthetic update on patient
Summary:
- Patient recovering well from anaesthesia and waking up appropriately
- Ears showing improvement but still red, sore with some discharge present
- Required general anaesthesia for thorough ear cleaning and treatment application due to patient non-compliance
- Anal glands expressed during procedure
- Patient behavioural issues with ear treatments and handling of posterior region
- Recovery proceeding normally
Action items:
- Call owner if patient ready for discharge before 3pm
- Otherwise discharge at 3pm as scheduled