C09985394 / invoice 10000

04/03/2026 Reason: Facial swelling follow-up
Presented by: Ben
History: 12-year-old female cat with ongoing facial swelling for approximately one year.
 Initially presented with facial swelling, suspected allergic reaction or tumour.
 Currently managed with prednisolone and doxycycline.
 Recent exacerbation occurred 4 days ago when prednisolone was missed while owner was away - swelling increased significantly with associated sneezing and wheezing, breathing difficulties.
 Responded well to 5 days continuous prednisolone followed by 3 days of full tablet dosing.
 Indoor cat that got into fight with neighbor's cat, confirmed bite to nose area.
Known problems: Chronic facial swelling, epiphora (improved on current treatment)
Diet: Good appetite, eating well
Current Medications: Prednisolone 0.5 tablet every second day (maintenance), doxycycline as needed for flare-ups

Examination -
Demeanour: QAR
BCS: 6
CVS: NAD
RESP: NAD
LN: NAD
GI: NAD
INTEG: Persistent bulge left aspect nose/bridge
MSK: NAD
OCULAR: Mucoid epiphora, improved on current treatment
EARS: NAD
DENTAL: Ok

Assessment: Chronic facial swelling, likely secondary to previous cat bite trauma. Prednisolone-responsive condition requiring ongoing management.

Diagnostics / Work-up Options: CT scan discussed - approximately $1500, may be covered by insurance.
 Plain radiographs less informative due to complex 3D anatomy.
 CT would provide prognostic information but unlikely to reveal surgically correctable lesion.

Treatment: Continue prednisolone at current maintenance dose. Doxycycline for flare-ups.
 Consider liquid prednisolone formulation for more precise dosing if needed.

Plan: 
- Continue current medication regimen
- Owner to discuss CT scan option with family
- Monitor for progression
- Surgical intervention unlikely due to complex nasal anatomy and high vascularity
- Long-term management approach with lowest effective prednisolone dose