C09983878 / invoice 10000

PCV - 32%TPP - 64g/LSerum Colour - clearInitials LDRTreatment: sedation Drug 1:   0.0125 dom  ml Drug 2:   0.5 methaodne  ml  IM Induce 2mls alfaxan slowley Monitor aryways  -no evidence of paralysis of the vocal folds Not a lot of moevement Waited until for a while and still no movement Decided to do add on dental and then re-examine Examine: After dental Extubated and visualised larynx Can see bilateral movement - video taken Assessment: No laryngeal paralysis Will be interesting to see if prevomax reduces the cough and wheez in the next 24 hours Differential Diagnosis: Chronic lung disease a sprevious diuagnosedPlan: Had diarrhoea on recovery so will give some prokolin 5mls twice daily It will be interesting to see if her coughing and wheezing are better in the next 24 hours - with cerenia on board Teeth are ok - although there is a small gingival mass that we need to monitor--- 27/02/2026 16:31:01 AN:Post Op Surgery - Nurse - Resolved - spoke to Giliian, Rufie still a bit quiet today but ate food well this morning and went out for walk ok earlier. hasn't had any poo yet. o coudn't give prokolin as Rufie didn;t want to eat food with it. probably will pass ok poo by tmrw. a bit of heavt breathing when going out but no coughing or wheezing. MS    Vital Signs    

Reason: GG - Beransa, Addison Inj, Breathing Issues (TB)Appointment Notes: Overdue remindersHistory: Plan: Adding in anything else ? - laser- synovan - antinol - paracetamol History:Presenting for: Patient presented for evaluation of progressive respiratory noise/stridor. Client reports the noise has worsened over time and is significantly exacerbated by exercise. A friend of the client (Jen Hern, a veterinary specialist) suggested the noise may be consistent with laryngeal paralysis.Historical Conditions:- Previous thoracic radiographs taken approximately 2024 - no evidence of laryngeal paralysis noted at that time- Previous trial of Lomatil - no improvement in respiratory signs- Previous recommendation to use steam/bathroom inhalation therapy - no improvement- History of hindlimb orthopaedic disease (degenerative joint disease)- Previous joint injection(s) for hindlimb disease - ongoing- Previous bloodwork performed - results within normal limits per veterinarianDiet:- Currently on a starvation/calorie-restricted diet- Appetite reported as goodV/D/C/S:- Intermittent mild coughing noted, particularly during exercise; not considered excessive by client- Significant inspiratory stridor/respiratory noise present, markedly worse on exertion- At rest, patient is reported to be largely silent or near-silentCurrent Meds:- Antinol (green-lipped mussel supplement) - daily- Paracetamol (Panadol Osteo 750 mg) - half tablet BID- Cortate (corticosteroid) - ongoing; dose recently increased by a quarter- Ongoing joint injection (presumed Zydax or similar) - monthly, ongoingLifestyle Risk Factors:- Exercise currently very limited due to respiratory compromise; client avoiding hilly walksOther:- Client's acquaintance Jen Hern (veterinary specialist, works at a specialist hospital - ) contacted client and suggested presentation is consistent with laryngeal paralysis and recommended referral for surgical evaluation- Client reports patient is bright and keen to go out despite respiratory limitationsExamination:Mentation: BARBehavioural: Friendly and social; readily approached veterinarianRespiratory: Significant stridor audible at rest during consultation. Lung fields auscultated - clear, no abnormal sounds detected.Musculoskeletal: Marked hindlimb weakness and muscle atrophy noted. Patient observed to hesitate and shift weight forward when sitting and rising, consistent with offloading hindlimbs. Gait shows compensatory weight distribution cranially with reduced hindlimb engagement. Stiffness noted in hindlimbs on observation.Assessment:Respiratory stridor - progressive, exercise-induced, worsening over time. Laryngeal paralysis is the primary differential given clinical description and pattern. Lung fields clear on auscultation; lower airway/bronchial disease cannot be fully excluded. Definitive diagnosis requires laryngoscopy under light anaesthesia to assess laryngeal fold movement. Hindlimb orthopaedic disease - chronic degenerative joint disease with significant muscle atrophy and compensatory gait changes. Currently managed with corticosteroid (Cortate), Antinol, Paracetamol, and periodic joint injections. NSAIDs contraindicated due to concurrent corticosteroid use.Dental disease - noted incidentally; teeth require assessment and cleaning under anaesthesia.Plan:Diagnostics:- Anaesthetic laryngoscopy to assess laryngeal fold movement and confirm/exclude laryngeal paralysis - planned for tomorrow (26/02/26); patient to arrive ~10:00, estimated discharge ~18:00- Thoracic and lumbosacral spinal/hip radiographs to be taken under the same anaesthetic to fully characterise hindlimb orthopaedic disease - particularly useful if physiotherapy is pursued- Estimated cost of laryngeal investigation: ~$1,100 (likely covered by insurance)- Estimated cost of radiographs: ~$340 (likely covered under a separate condition claim)- If laryngeal paralysis confirmed, video of laryngoscopy findings to be recorded and forwarded to specialist (Jen Hern / Ballard specialist hospital) for review and surgical consultationMedications/Treatments:- Dental scale and clean to be performed under the same anaesthetic- Estimated dental cost: ~$338 (unlikely to be covered by insurance, but significantly reduced given shared anaesthetic costs)- Zydax injection administered today- Regarding surgical management of laryngeal paralysis (tie-back/arytenoid lateralisation): veterinarian does not perform this procedure due to infrequency of cases and associated complication risk. Referral to specialist strongly recommended. Risks of surgery discussed: significant vasculature and nerve proximity, post-operative aspiration pneumonia risk, increased infection risk due to loss of normal laryngeal protective function. Procedure is not considered simple despite client's acquaintance describing it as such.- NSAIDs (e.g. Meloxicam) contraindicated due to concurrent Cortate use - risk of gastrointestinal ulceration. Gut-sparing NSAIDs noted as an option only if pain management becomes inadequate and benefit outweighs risk.New Meds/Tx:- Veterinary physiotherapy referral discussed - in-house physiotherapist (Stella) available; services include underwater treadmill, laser therapy, dry needling, and electromagnetic field therapy. Goal is to build muscle mass around affected joints to reduce load. Initial assessment $165; subsequent sessions $100 each (or prepaid rate). Some sessions may be covered by insurance.Diet Recs:- Discussed increasing dietary protein and reducing kibble to support muscle mass - recommended as a starting point for nutritional management of muscle atrophyAdditional Discussion:- Insurance: client confirmed active insurance policy; veterinarian to load laryngeal investigation and radiographs under insurance. Dental to be billed separately. Client likely on 80% cover.- Cortate to be given as normal the morning of the procedure tomorrow- Veterinarian to contact specialist surgeon to enquire about volume of laryngeal paralysis cases performed at the referral centreClient Comms:- No food the morning of the procedure; Cortate to be given as normal- Drop-off ~10:00, estimated pick-up ~18:00- Insurance to be claimed for laryngeal investigation and radiographs; dental unlikely to be covered but cost reduced due to shared anaesthetic (~$338)- If laryngeal paralysis confirmed, referral to Ballard specialist hospital (Jen Hern's team) for surgical consultation will be recommended- Physiotherapy discussed as beneficial adjunct for hindlimb disease - encouraged to consider given patient will already be under anaesthetic for radiographs    Vital Signs