C09997588 / invoice 10000

Reason: Small Animal Internal Medicine - Initial Consultation**Current Problems: Panting and lethargy.Referred by: MVSCRecord is CompleteVet/Nurse TJ/JA/AK/RHHistory summary:Merlot is a 5yo MN German Shepherd, presenting for increased panting. Previously wokred up at U-Vet for increased panting, decreased exercise tolerance, weight loss and nasal sounds, which was diagnosed with possible widespread inflammatory disease.History:** Five-year-old male neutered German Shepherd presented for investigation of panting and lethargy. The referral is from MVSC, where the patient has been managed for atopic dermatitis since 2022. The owner reports an increase in panting and harder breathing, occurring even at rest. There is a history of losing two previous dogs to cancer with similar initial signs, causing significant owner concern. Appetite, thirst, and urination/defaecation are normal. No coughing has been observed. A chronic, intermittent gurgling/choking sound is noted from the throat, particularly when sniffing, which was previously investigated at Uvet. The patient appears subdued and lethargic in the clinic, a change also noted by nursing staff at the primary vet clinic. However, the owner reports normal activity levels at home, including play with a new puppy.**Age obtained:** not discussed**Place obtained from:** not discussed**Vaccination Type:** not discussed**Preventatives:** not discussed**Regular diet:** not discussed**Previous diets:** not discussed**Environment:** Lives with an 8-week-old puppy.**Exercise tolerance**: Walks 2-3km daily. Active at home with a new puppy. Reported to be very subdued and lethargic in the clinic environment. Not friendly with other dogs.**Travel history**: not discussed**Other pets**: An 8-week-old German Shepherd puppy at home, in good health.**Behaviour concerns:** Very anxious dog, particularly in new environments and with groups.**Other concerns:** Owner is very worried about the possibility of cancer due to the history of two previous German Shepherds dying from cancer after presenting with similar signs.**Current medications:** Cyclosporine (compounded, then Neoral) and Clindamycin for atopic dermatitis. Has fortnightly skin checks.**Concurrent or prior pertinent disease:** History of atopic dermatitis since 2022. History of eosinophilic disease. Previous workup at Uvet for gurgling throat sounds, which reportedly revealed infection.**Physical Examination:**HR: 80 BPMRR: 36 rpmTemp: not performedMM: noneCRT: noneMentation: Subdued.Demeanour/Behaviour: Quiet and subdued in the consulting room. Anxious.Oral/Dental Score: not gradedBody Condition Score: 5/9. Large dog, 42.7 kg.Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous. Femoral pulses difficult to palpate as patient kept sitting down.Respiratory:thoracic auscultation clear sounds bilaterally, respiratory effort increased. No nasal discharge.Neurological:Triceps reflex negative. Gait and movement to be assessed outside.Musculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painAbdominal: no detectable pain on abdominal palpationRectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: Coat is shiny and in good condition despite history of skin disease.Lymph Nodes: NSFEyes: NSF**Assessment:**- Tachypnoea/panting: Urgent investigation required.**Plan:**- Diagnostics: Plan is for a full workup today. This includes chest X-rays and a focused abdominal ultrasound (assessing spleen) under light sedation. Blood tests to be performed include CBC, biochemistry, T4, and TSH. A free-catch urinalysis will also be collected. Extra blood to be collected for potential further testing (e.g., Aspergillosis serology) given the breed and history. Blood pressure to be taken in the room with the owner present.Therapeutic: NoneTreatment: None**Summary:** Merlot is a 5-year-old MN German Shepherd presenting for investigation of panting and lethargy. The owner is highly concerned about the potential for neoplasia. Examination reveals a quiet but anxious dog with an increased respiratory rate and effort. A full diagnostic workup including imaging and blood/urine testing is planned for today to investigate the underlying cause.**Client Instructions:** The diagnostic plan, including sedation for imaging, and associated costs were discussed with the owner. The owner has consented to proceed with the recommended workup today.**Client Communication:** The plan for chest X-rays, focused abdominal ultrasound, blood tests, and urinalysis was outlined. The need for light sedation for X-rays was explained. A cost estimate of just under $1800 for the diagnostics and consultation was provided and approved by the owner. The owner's significant concern regarding a potential cancer diagnosis was acknowledged.Previous medical history:History of suspect atopic dermatitis, last flare occurred in Nov 2024History of ID furunculosis that appeared in 2023 and resolved with antibioticsMedications:Current:Cyclosporin 1mL EODPreviousAmoxyclav - finished june 2025Fluconazole - finished July 2025Prednisolone - finished July 2025**Initial Work-up Results:**The initial work-up was performed at U-Vet prior to 20/04/2022 for investigation of increased panting, decreased exercise tolerance, hypo- to anorexia, weight loss, and stertor.- **Laboratory work:** Mild eosinophilia.- **ACTH stimulation test, B12, folate:** Within normal limits.- **CT (nose, chest, abdomen):** - Unremarkable thorax. - Moderate splenomegaly, likely GI-related. - Mild jejunal lymphadenomegaly. - Mild thickening of the rostral nasal mucosa and retropharyngeal lymph node. - Enlarged left tonsil. - Transitional eighth lumbar vertebra.- **Bronchoalveolar Lavage (BAL):** Mixed (eosinophil-rich) inflammation, mucus hypersecretion, respiratory cell hyperplasia and dysplasia.- **Respiratory PCR:** Negative.- **Biopsies (nose, tonsil, stomach, duodenum):** Mild lymphoplasmacytic and eosinophilic inflammation in all sites.- **Culture (tonsil, BAL):** No significant growth.**Current Medication (as of 04/03/2026):**- Cyclosporin 1ml, every other day.- Medicated wipes (ordered online) for paws and perianal area, every other day.- Nexgard Spectra monthly.- Probiotic once daily.**Reaction to Prednisolone:**- **Infection:** History of superficial bacterial folliculitis (Staphylococcal infection) on the belly and back, presenting as scaling and post-inflammatory hyperpigmentation, noted after ceasing prednisolone. This was considered a normal "catch up period of scaling" (18/05/2022).- **Flaring of atopy:** Atopic signs (itch, pododermatitis) have flared when prednisolone was ceased or tapered, requiring reintroduction of the medication (e.g., April 2024, November 2024, June 2025).**Last Administration of Prednisolone:**- A course of prednisolone 20mg was completed in July 2025.**Last Blood Test:**- **Date:** 03/05/2022.- **Tests performed:** Cyclosporin trough concentration and HESKA ALLERCEPT Allergen-Specific IgE Serology.- **Results:** - **Cyclosporin trough concentration:** 137 ng/mL (Target range for chronic inflammatory disease: 100 - 600 ng/mL). - **Allergen-Specific IgE Serology:** Showed elevated IgE suggesting allergies to:  - Melaleuca (194 HERBU)  - Alternaria (mould) (60 HERBU)  - Flea Saliva (52 HERBU)  - D. pteronyssinus (dust mite) (34 HERBU)  - Ant (32 HERBU)  - Tyrophagus putrescentiae (storage mite) (31 HERBU)  - D. farinae (dust mite) (29 HERBU)  - Mugwort (22 HERBU)    Vital Signs    Weight: 42.2;       MMColour: Pink;       Temperature: 38.2;       HeartRate: 80;       BodyScore: 5/9;       DentalGrade: 0/4;       RespirationRate: 36;       PainScore: 5/24;       CRT: 1 sec;       

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