C09998165 / invoice 10000

PROCEDURE:

PRE-GA EXAM:
BAR
TPR WNL
abdo comfortable
_

PRE-GA BLOODS:

ANAESTHESIA:
Pre-med: _ IM
_ G  catheter placed _ cephalic
Induction: _ slow IV, to effect
Maintenance: Isoflurane, size _ ET tube, cuff inflated and tube secured
Anaesthesia and recovery uneventful

Peri-operative medication:
IVFT LRS @ _

SURGERY:
The surgical site was clipped and aseptically prepared.
An elliptial incsion was made around the mass. The mass was blunt dissected away from underlying tissue. The subcutaneous layer was closed with _. The skin was closed with _.

Post-operative medication:


POST-OPERATIVE INSTRUCTIONS:
Lily has been a lovely patient while in hospital with us at Bundoora Vet Clinic.

Today she was admitted to hospital to correct an aural haematoma, under general anaesthetic. Stents were placed on the ear to help facilitate drainage and ensure the hemetoma does not reform. Please note there is an incision on the inside of the ear, where further blood may drain from - this is what we want!

Lily has an ear infection in both ears. A long acting ear medication was placed in both ears - you should not need to do anything at home for the next week. A review is due in 1 week, we will re-check the cytology to see if the infection has healed but it is likely a second dose of the medication will be needed. If that is the case, please come back the following week so we can re-check the ear cytology and ensure the infection has healed. Lily's ear drums were intact today. If you notice any head tilt, reduced hearing or ataxia (looking like she is drunk when she is walking), please bring her back ASAP as it may indicate that her ear drums have ruptured. If this is the case, we will need to flush her ears out under a general anaesthetic, as the medication can be toxic to the middle ear (which is normally protected by the ear drums).

Please keep her quiet and confined while she is recovering. We are sending them home with medication, please give as directed on the label.

Please book them back to us for a recheck in 7 days, for her next ear infection medication dose but please come back sooner if you are concerned. The stents will likely be removed at the 14 day mark. Please give the trazodone and gabapentin BEFORE this consult, as directed on the label - these medications will aim to calm Lily and enable us to hopefully remove the stents conscious. Please note that if she is not tolerant, then we may need to sedate her.

Please take the bandaid off the forelimb when you get home, where the catheter was placed. Please ensure she wears the e-collar so that she cannot scratch and traumatise her ear further

It has been our pleasure to care for Lily. Please do not hesitate to contact us if you have any concerns, we wish them a speedy recovery.

Presenting for: Aural haematoma

HISTORY
- Noticed swelling on ear 3 days ago. 
- O has not seen much shaking head or scratching at ears. 
- EDDU normal. No V+ or D+. No coughing or sneezing

EXAMINATION
Mentation: BAR, anxious - limited exam, no muzzle **did whip head around when swabbing right ear, is ok if you go slow**
FAS score: 4/5
HR = 120 bpm, no heart murmur or arrhythmia detected on ausc  
Resp rate = WNLs, Normal resp effort and clear BVS, no crackles and wheezes 
Throat: no tracheal pinch
Eyes: clear and bright corneas, no discharge
Ears, Both ears: small amount waxy, brown discharge. R ear: large, circular, firm, fixed mass on R pinna
Nose: clear, no discharge
LNs: Submandibular NAD
MSK: ambulatory x4, no obvious lameness
Integument: healthy, well kept coat
BCS: 6/9

EAR CYTOLOGY
R ear: + rods, +++ cocci, + yeast 
L ear: ++ cocci, + yeast

ASSESSMENT & PLAN
1. Bilateral otitis externa and R aural haematoma (R > L)
Booked tomorrow for surgery to drain/stent haematoma. Will also need tx for ear infection tomorrow after investigation of TM (BNT might be easiest to prevent further head shaking when administering ear meds?). Unlikely to need ear flush but did discuss possibility with O. 

COMMUNICATION
As above. 

Second Opinion:


Below is an update for Lily Staesk, who is recovering well following a median sternotomy with partial lung lobectomies to treat a recurrent spontaneous pneumothorax. The owner reports that Lily has been doing well since surgery and has no concerns.

Examination findings:
At today’s examination, Lily is breathing well and thoracic auscultation is normal The incision has healed well.

Treatment:
The staples were removed. Blood was collected for a heartworm test (negative).

Assessment: Surgery has resolved the immediate urgency regarding recurrent pneumothorax however histopathology did identity some other lung changes, as well as the bulla formation, that indicated some underlying lung disease. Dr Labuc from the medicine department was consulted and recommended a heartworm test (negative) and to consider electrocardiography to rule out right sided heart disease which could result in pulmonary hypertension.

Plan:
I have recommended a return to normal exercise and to monitor for any breathing difficulty. An echocardiogram to investigate right sided heart dieae/pulmonary hypertension can also be considered.

Thank you for this referral. Please contact the clinic if you have any further questions regarding this case, or any other surgical cases, on the number below or for after-hours surgical emergencies on 03 9379 0700.

Kind regards,


Dr. Simon T. Kudnig BVSc, MVS, MS, FACVSc, Dip.ACVS <br>
Specialist in Small Animal Surgery <br>
ACVS Founding Fellow of Surgical Oncology <br>