C09985925 / invoice 10000

pre ga exam nad.pre ga bloods nad.Premedicated with dom 3mcg/kg and methadone 0.3mg/kg IMCerenia IV prior to inductionInduction with alfaxan titrated dose.Maintained on iso/O2.Monitored constantly by anaesthetic nurse manually and with capnography, doppler blood pressure, apalert, pulse oximetry and oesophageal stethoscope.Local- line block over incision site. Splash over ovarian ligament at start of surgery.Ovarian pedicles tied with 2x circumfrential ligatures and 1x transfixing ligatures with 2.0 PDS Body of the uterus ligated with 2x circumfrential ligature and 2x transfixing ligatures with 2.0 PDS Stumps inspected for bleeding. No bleeding detected.Linea alba - external rectus sheath closed with 2.0 pds simple continuous sutures.Subcutaneous layer closed with 3.0pds simple continuous sutures.Skin closed with intradermals 4.0 PDS skin suture.Recovery smooth.Nurse tattooAGs expressedEARS cleaned out & TM intact bothCYTOLOGYBNT 2.5ml both earsDental grade 2- upper carnassial & molars, cracked calculus off & scale and polish done. remainder teeth good grade 1REGURGITATION near end of dental- cleaned back of throat out well, extubated last minute and with cuff 1/2 up. Lungs clear.dom half premed dose IV- Smooth recoveryMetacam injection on recovery. Home with metacamPLANrv with a vet in 7 days and q week until cytology on ears clearno plucking of earsif ears flare up post groom again- elocon or dex + gentle ear cleanerO ok for traz if needsO may change from buster to kong cloud

a) vacc and parasite control utdb)c) discuss desexingCCCurrent medication & dose: none------------------------------------------Vital Signs:- Weight: 19.6 kgHistory:- Presented for general check-up, dental assessment and discussion regarding desexing.- Eating and drinking well. Currently on puppy food (Bozita Chicken Puppy Big Dog), owner considering changing to adult food.- One heat cycle approximately 4 months ago.- No pre-existing medical issues reported from previous vet (Mulver Vets).- Owner reports halitosis.Physical Exam Findings:BCS: 4/9Mentation: Bright, alert, and responsive.Behaviour: Gentle and calm during examination.Eyes: Normal.Right ear: Erythema and ceruminous debris present. Otoscopic examination reveals a large amount of hair and debris obscuring the tympanic membrane. Left ear: Normal. MM Pink and moist.CRT <2 secondsDental - disease grade 3 affecting upper carnassials and molars bilaterally. Gingivitis. Remaining mouth Grade 1 disease otherwise.Lymph Nodes- Normal on palpation.Cardiovascular- Heart rate 108 bpm, regular rhythm. No murmurs or arrhythmias auscultated.Respiratory- Clear on auscultation.Abdomen- Soft, non-painful on palpation. No organomegaly.Musculoskeletal- No pain on palpation of limbs or spine. Hips normal.Integument- Skin normal.Urogenital Vulva normal in size and appearance.Neurological Normal gait and mentation.Diagnostic Results- Otoscopic cytology (right ear): Heavy yeast infection identified (Malassezia) >20 budding yeast per HPF. left ear clearAssessment:- Problem list:1. Malassezia otitis externa, right ear.2. Dental disease (Grade 3) upper carnassials 3. Discussion regarding desexing.Plan:- Malassezia otitis externa: Commenced Surolan ear drops, 0.8 mL into the right ear daily for 7-10 days until bottle is finished.- Dental disease: Discussed need for dental radiographs and a dental procedure under general anaesthetic to assess and clean teeth. Advised this should be done as a separate procedure from desexing to reduce infection risk.- Desexing: Discussed ovarian hysterectomy. Options including standard surgery versus laparoscopic surgery were provided. Also discussed prophylactic gastropexy due to deep chest conformation, which can be performed concurrently with desexing.- Follow-up care: Recheck in 10-14 days for ear examination to ensure resolution of infection. Book for desexing procedure at owner's convenience.- Advised on ear cleaning at home using Johnson & Johnson baby shampoo on a cotton bud to help dissolve wax, but not to insert deep into the ear canal.Communications:- Discussed findings with owner, including the diagnosis of a yeast infection in the right ear and the plan for treatment.- Explained the dental disease findings and the recommendation for a dental procedure.- Discussed desexing options, including timing, surgical procedures, and the option of a prophylactic gastropexy.- Advised that dental and desexing procedures are best performed separately to minimise anaesthetic time and infection risk.- Provided instructions on ear drop administration and home ear cleaning.- Confirmed microchip details (956000016547).