C09994659 / invoice 10000

HISTORY- Suspected hearing issues; does not react to sounds- Chronic ear issues with thickened ears noted- Possible underlying allergies; licks paws and shakes head- Previous difficulty administering ear medicationEXAMEars: Very thickened crusty skin, malodorous discharge, extremely narrowed canals, painful (more on the Rt side)Eyes: Cloudy lenses, possibly age-relatedTeeth: Worn but no tartar or gingivitisMucous membranes: Pink and moistHeart: Sounds good, no murmursLungs: Sound clearBody condition: ExcellentSkin: Pink skin between digits, pruritic bottomGait: GoodAbdomen: No abnormalities on palpationDIAGNOSIS- Chronic otitis externa with suspected underlying allergies (cocci and budding yeasts on DQ stain)PLAN1. Administer Neptra in both ears2. Administer Cytopoint 40 mg3. Conduct a food allergy trial with a hypoallergenic diet for six to eight weeks - send info on this and owner can proceed AFTER we treat current acute issues4. Recheck in 3 to 4 weeks5. Referral to skin specialist if not improving6. Pre-visit medication for next visit: 1.5 tablets of 100 mg Trazodone and 300 mg Gabapentin the night before and 2 hours before the visit

Purpose: Anxiety reduction before Vet visit or for travel?Please dispense enough for 4 doses or 4 visits (can dispense more than 4 doses if pet will always need a dose the night before as well as on the day of Vet visit)Gabapentin (dose is 10mg/kg, can round up)number dispensed: 300mg x 4AND Trazodone (dose is 5mg/kg or if very severe anxiety 10mg/kg rounded down)number dispensed: 100mg x 6One dose = 300mg Gaba & 100mg Trazo (can have 300mg Gaba & 150mg Trazo the night before if needed)Label for Gaba:Please give ONE capsule 2 hrs before Vet visit, if this isnt enough can also give ONE capsule 12 hrs before as wellLabel for Trazo:Please give ONE & A HALF tablet 2 hrs before Vet visit, if this isnt enough can also give ONE & A HALF tablet 12 hrs before as well - SH changed label 13/2/26

PRESENTING COMPLAINT:dog fight wound around eyeHISTORY:~10min ago. Hippo was in front yard. approached passing by staffy and they fought. other dog latched on to the R side of Hippo's head/eye.O of other dog tried to break up fight.wounds on R side of head + R eye.otherwise has been okay since fight.anxious dog.hx OE - O unable to give ear meds consistently due to anxiety.EXAMINATION:Eyes: puncture wounds on lower eyelid of R eye. R eye globe appears normal, still visual and intact. no wounds around L eyeMM: Pink and moist, CRT: <2s.HR = 80 = PR, heart sounds normal, femoral pulses normal, RR = 40, chest sounds clear, Abdo & peripheral LNs: NAD,Coat & skin: 1cm puncture wound (extends through skin layer only) on top of head over R eye with scratch extending rostrally with 0.5cm partial puncture wound at end. Mild crepitus over R side of face.Otherwise NAD.Ear cytology - L ear yeast ++, R ear yeast ++PROBLEM LIST:multiple puncture wounds on headongoing bilateral OEASSESSMENT: Dog fight wounds to be cleaned and treated. No other injuries noted as result of fight. All vital normal, clinically stable. Ongoing OE likely due to lack of consistent tx - anxious dog.TREATMENT in consult room/Meds dispensed:0.8ml methadone + 0.28ml medetomidine IM2.75ml betamox SCTGH 40mg onsior PO SID for 7 daysTGH 375mg amoxyclav PO BID for 7 daysPLAN:RV in 2-3 days to recheck wounds.Continue apex PMP in both ears for 7 days. Ideally rpt ear cytology in 7 days but very anxious dog.Told O to visit emergency hospital if concerned overnight.Medications to continue with until next meds review: none