C09985415 / invoice 10000

Reason: Sedate FNA Nails GHE Ears & VaccsAppointment Notes: JR  ------- Sms reply: Yhistory:Presented for sedation to check skin lumps. also is due for vacc Cleo had breakfast at 7 am. the skin lumps do come and go, and occasional has rashes on the abdomen as well Examination:BAR: Initially anxious, became progressively drowsy following sedation.Temp: 38.6CCVS: no murmur or arrhythmia, femoral pulse strong regular.Resp: normal bronchovesicular lung sounds bilaterally.Eyes: no redness/ excessive or abnormal discharge.Ears: not fully examined due to patient temperament.Mouth: pink moist crt <2s . Mild generalised gingivitis and plaque, particularly on canines.LNs: submandibular, prescapular, popliteal WNL.Abdominal palpation: soft, no pain detected .Skin: Multiple small lumps throughout the dorsum underneath the skin --> appears to be hives likeMusculoskeletal: normal gait, normal rom, no MPLs, no pain .Urogenital: no abnormalities found .Neurological: full exam not performed, normal mentation , no neurological signs shown .Laboratory:NILAssessment:1. Skin lumps/hives:- Allergic reaction (e.g., environmental, contact)- Folliculitis- Insect bites2. Mild dental disease:- Gingivitis- Plaque/tartar accumulation3. Occasional reverse sneezing:- Allergic rhinitis- Nasal irritationTreatment:Sedation administered IM for examination: butorphanol 0.3mg/kg + 15mcg/kg medetomidine IM (some came out and didnt inject properly) reversed with 0.2ml of atipam as not sure the full dose was go inPlan:- Trial Zyrtec for skin lumps. Start with two tablets twice a day. If effective, this suggests an allergic aetiology. Can reduce to one tablet to see if it maintains control. Advised to administer whenever a flare-up occurs.- Monitor dental health. Continue with dental additives in water and dental chews. If plaque and inflammation worsen, a future dental scale and polish may be required.- Patient is likely to be sleepy for the remainder of the day.    Vital Signs    

Reason: Vax? + Lump Check Appointment Notes: Needs meds before coming in -mbhistory:Cleo presented for a check-up, assessment of skin lumps, and discussion regarding ongoing anxiety. Vaccination is due on 14/03/2026 but may be administered early if health check is clear. Owner reports ongoing anxiety despite fluoxetine treatment, and recent changes in eating behaviour. Ear irritation and long nails were also discussed.Examination:limited exam dt being aggressive when doing certain things BAR: bright, alert, responsive, but anxious in the clinic setting.LNs: submandibular, prescapular, popliteal WNL.Skin: A mobile, soft, subcutaneous lump felt. Not painful on palpation and Cleo does not appear irritated by it. History of other wart-like, pinky-white papules on the dorsum that appear and resolve spontaneously. Also a history of transient rashes on her abdomen.Ears: Owner reports signs of irritation (head shaking). Examination difficult due to patient anxiety and aversion to ear handling. History suggests irritation may have started after use of a high-pitched anti-barking collar approximately one year ago.Musculoskeletal: Nails are long.Laboratory:NILAssessment:1. Anxiety: Currently on fluoxetine 1.5 tablets daily. Owner reports persistent anxiety symptoms (e.g., barking at passersby). Weight is 24.5kg.- Differentials: Generalised anxiety disorder, separation anxiety, noise phobia, learned behaviour.2. Subcutaneous lump(s): Mobile, soft lump noted. History of other transient wart-like lesions.- Differentials: Lipoma, sebaceous cyst, histiocytoma, mast cell tumour, skin tags/viral papillomas.3. Otitis/Ear Irritation: History of head shaking and discomfort.- Differentials: Otitis externa (allergic, infectious - yeast/bacterial), foreign body, behavioural (secondary to anxiety/collar use).4. Long nails: Overgrown.5. Inappetence/Picky Eating: Recent history of refusing kibble unless owner is present, or if additives (yoghurt, water) are mixed in. Eats dinner normally. Eats treats readily. No weight loss noted.- Differentials: Behavioural (attention-seeking, food boredom, learned aversion), dental disease, GI discomfort.Treatment:Prescription for fluoxetine provided.Plan:- Increase fluoxetine dose to two tablets daily to manage anxiety. Advised owner that it may take up to four weeks to see the full effect.- Discussed continuing with behaviour training to manage triggers for barking.- Plan for a sedated examination to be booked. This will allow for:    - Fine needle aspirate (FNA) of the skin lump.    - Thorough otoscopic examination.    - Thorough dental examination.    - Nail trim.- Advised owner to fast Cleo prior to the sedation appointment. A date for the procedure was discussed for the 27th in the afternoon.- Recommended trialling a different food, such as Royal Canin, as it is often more palatable. Advised to purchase a small bag initially. Discussed possibility of chin acne with oilier foods and to wipe face after meals if it occurs.- Will consider giving C3 vaccination at the sedation appointment if Cleo is otherwise healthy.- Provided a script for fluoxetine 20mg tablets (56 tablets with 5 repeats), for a total of six months supply at the new dose.# of items Dispensed:Rx:	fluoxetine 20mg tablets Mitte:	x56 tablets .Directions:	…Give 2 tablets once a day. Do not stop suddenly 5 REPEATSKEEP OUT OF REACH OF CHILDRENFOR ANIMAL TREATMENT ONLYVet Signature: ………………………………………….Vet Name: Dr Cindy Hak Sin Ma QLD V6299--- 21/02/2026 09:35:38 AM SN8:Examinations - Resolved -    Vital Signs    Weight: 24.5;       

Appointment Notes: Booked Online: 01/09/2025 08:14:58 AMBooking Type: Health CheckBooking Notes: Review of her fluoextine doseOwner Name: JAime ODonovanOwner Email: jaimeodonovan@hotmail.comOwner Mobile Number: 0433031747Pet Name: CleoPet Species: DogWeb BookingClient name: ODonovanContact number: 0433031747Email address: jaimeodonovan@hotmail.comPatient name: Cleohistory:Leo is here for a review and a new script for fluoxetine for anxiety. The owner reports that weaning down to one tablet daily was unsuccessful, resulting in worsening behaviour. Leo is currently on one and a half tablets daily, which is more effective. The primary behavioural concern is excessive barking at people walking past the house and at the neighbour's fence. The behaviour is worse in the mornings and afternoons and when the owner is present. Pulls on the lead towards other dogs, but is playful and social at the dog park. Past mouthing behaviour when anxious has resolved with fluoxetine and training with a dog behaviourist. The owner has implemented strategies from the behaviourist, such as having visitors get down low, which has been effective. The owner also notes Leo shakes her head and scratches her ears after barking.Examination:BAR: Bright, alert, and responsive. Anxious and jumpy during the consult.Eyes: Bright and clear, no discharge.Ears: Both ear canals appear erythematous, more so in the right ear. No discharge visualised externally.Nose: Clear, no discharge.LNs: Submandibular lymph nodes palpate normally.CVS: No murmur or arrhythmia auscultated.Abdominal palpation: Soft and non-painful on palpation.Skin: Small palpable lump on the left chest wall, reported by the owner to be scar tissue from a previous mass removal.Musculoskeletal: Good range of motion in front limbs.Laboratory:Ear cytology (both ears): No bacteria or yeast identified. Mild inflammation noted.Assessment:1. Behavioural anxiety: Differentials include generalised anxiety, separation anxiety, territorial aggression.2. Bilateral otitis externa (inflammatory): Differentials include atopic dermatitis, food allergy, contact irritation.Treatment:Fluoxetine 30mg once daily to be continued.Steroid ear cleaning solution to be prepared for collection.Plan:- Continue fluoxetine 30mg (one and a half tablets) once daily. Dispensed 5 months' supply.- Prepare a steroid-based ear cleaning solution for weekly use to manage inflammation. Owner to collect when ready.- Advised owner to monitor ears for increased redness or any brown/yellow discharge, which may indicate a secondary infection.- Continue with current behavioural management and training strategies.- Discussed situational anti-anxiety medication as a future option if needed for escalating behaviour, but not required at this stage.- Recheck due in March for annual vaccination.Rx:	fluoxetine 20mg tablets ..Mitte:	…56 tablets Directions:	Give 1.5 tablets orally once a day. Do not stop suddenly 4 REPEATSKEEP OUT OF REACH OF CHILDRENFOR ANIMAL TREATMENT ONLYVet Signature: ………………………………………….Vet Name: Dr Cindy Hak Sin Ma QLD V6299--- 04/09/2025 08:57:10 AM JRR:Examinations - Resolved -    Vital Signs