C09983563 / invoice 10000

Reason: History: Clinical SummarySEDDON Hx: : Sunny RickardsOngoing/Chronic Problems:- Neurological Disease: Long-standing history since puppyhood (Nov 2021) with features suggestive of cerebellar disease.- Signs include intention tremors, hypermetric gait (worsened by excitement), and episodes of muscle weakness/partial paralysis when woken suddenly (suspected cataplexy).- Also presents with episodes of manic barking/screeching, body stiffening, and urination, which are concerning for seizure activity.- MRI at 4 months of age did not confirm cerebellar hypoplasia but could not rule out a storage disease. A repeat MRI has been discussed.- Recurrent Otitis Externa: Primarily yeast (Malassezia) infections, affecting both ears at different times.- Dental Disease: Recurrent issues with gingivitis and halitosis, disproportionate to the level of tartar. Requires regular dental scale and polish procedures under anaesthesia.Chronological Summary of Encounters:- 06/06/2023:- Problem: Consultation for ongoing neurological signs.- Plan: Referral to a specialist neurologist for repeat MRI was recommended.- 09/11/2023:- Problems: Bilateral yeast otitis externa; right eye conjunctivitis.- Drugs: Easotic ear suspension; Amacin eye ointment.- 11/01/2024:- Problem: Follow-up for difficult ear treatment; ongoing dental concerns.- Plan: Recommended dental procedure (COHAT) with ear flush under anaesthesia.- 30/01/2024:- Problems: Dental scale and polish performed; right yeast otitis externa identified and treated.- Drugs: BNT ear ointment (in-clinic); Amoxyclav tablets.- 29/04/2024:- Problems: Malassezia dermatitis of lip folds; left yeast otitis externa.- Drugs: Malaseb shampoo; Canesten cream (recommended); Easotic ear suspension. Gabapentin was recommended for anxiety/compliance but declined by the owner.- 12/02/2025:- Problem: Annual check-up. Neurological signs (intention tremors) noted to be worse when eating.- Plan: To obtain notes from the neurology specialist.- 02/07/2025:- Problems: Facial rubbing; progressive neurological signs; dental disease.- Drugs: Amoxyclav tablets.- Plan: MRI discussion revisited; dental scale and polish recommended.- 08/09/2025:- Problems: Dental scale and polish performed; bilateral yeast otitis externa identified and treated.- Drugs: BNT ear ointment (in-clinic).- 24/09/2025:- Problem: Post-dental check. Persistent yeast otitis identified on cytology despite minimal clinical signs.- Drugs: Cortavance/Canesten solution for ongoing weekly management.History: Sam LONG:Patient: Sunny (Male Cocker Spaniel, DOB: 21/06/2021)Owner: Ms Katie RickardsSummary of Clinical HistoryChronology of Events:- 19/11/2021: First documented generalised intention tremors, noted with feeding.- 20/11/2021: Assessment revealed generalised tremoring and a decreased menace response in the left eye. Bloodwork showed mildly elevated phosphorous, cholesterol, ALP, and C-reactive protein.- 23/11/2021: Presented following an abnormal neurological episode characterised by heaving, lateral recumbency, limpness, subsequent hindlimb stiffness, staring, and vocalising.- 16/12/2021: Brain MRI showed subtle, non-specific changes to grey and white matter; storage diseases could not be excluded. Cerebellar hypoplasia and hydrocephalus were not seen. CSF tap was unremarkable.- Over the last year (approx. 2025): Five "panic attack-like" episodes and some episodes of muscle weakness have been reported.Clinical Signs on 02/03/2026:- General: Bright, alert, responsive, and anxious.- Neurological Examination:- Mild intention tremors present.- Menace response absent bilaterally (PLRs intact).- Possible ventral positional strabismus.- Gait is ambulatory with mild hypermetria and possible cerebellar ataxia.- Overall findings: Consistent with cerebellar dysfunction.Medications:- No medications are currently being administered.Hx from ARH:Based on the patient history provided for Sunny, here is a summary of the clinical signs, drugs, and dates.Clinical Signs-Generalised intention tremors, first documented on 19/11/2021, worse when concentrating (e.g., eating, sniffing).-Decreased menace response in the left eye (20/11/2021), later noted as bilaterally absent, but potentially obscured by long eyelashes.-Diarrhoea (initially bloody and mucoid, later soft serve consistency) and intermittent vomiting.-An abnormal neurological episode (21/11/2021) described as heaving, lateral recumbency, diffuse limpness, followed by hind leg stiffness, staring, and vocalising (potential seizure).-Clumsy gait, described as "wonky" and running "like a rabbit"; face-planting, tremors when going down stairs.-Slow and unusual drinking pattern.-Jolting up from sleep.-Dry coughing/throat-clearing started approximately four days before 06/12/2021.-Anxious behaviour.-Gait appeared somewhat ataxic with possible slight hypermetria of front limbs and shorter steps with hind limbs carried under the abdomen.-Reduced ability and reluctance on wheelbarrowing and hemiwalking.-Slight discomfort on palpation of the high neck/cranium.Drugs-Prokolin: Used for diarrhoea around 20/11/2021.-Metrogyl (Metronidazole): Used for diarrhoea, treatment stopped the day before 06/12/2021.-Doxycycline: On this medication as of 13/12/2021.-Cough syrup: Administered prior to 13/12/2021.-Gadobutrol: Administered IV for contrast MRI on 13/12/2021.-NSAIDs: Suggested as a trial therapy on 22/12/2021.Key Dates-19/11/2021: Generalised intention tremors first documented.-20/11/2021: Assessed for tremors, decreased menace response noted; treated for diarrhoea.-21/11/2021: Presented with an apparent seizure-like episode.-23/11/2021: Presented to Advanced Vetcare for the neurological episode.-06/12/2021: Internal Medicine consultation. History of tremors for approximately 6 weeks noted. Physical and neurological examinations performed.-13/12/2021: Admitted for MRI and CSF tap.-16/12/2021: MRI and initial CSF results discussed with the owner.-22/12/2021: Final results (negative neuro PCR panel) and plan discussed via email, including suggestions for an NSAID trial or referral to a specialist neurologist.Examination: Laboratory: Assessment: Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:    Vital Signs