C10008680 / invoice 10000

Reason: Swollen FaceAppointment Notes: Overdue remindersHISTORY:  Presenting complaint is acute onset facial swelling, noticed around 8pm yesterday (09/03/2026). The owner reports the swelling was not present at 3pm yesterday. The swelling was initially located lower on the face and has since moved up towards the eye. A similar issue occurred in June of the previous year. The patient is an indoor dog, only going outside for toileting. He is reported to be eating well (soft food), not lethargic, and the area is not painful.The patient was seen at Northlakes emergency vet at 9pm on 09/03/2026. No specific diagnostics or treatments from that visit were mentioned. Current meds: Metacam. Also receiving a course of four monthly injections, the second of which was administered on Saturday, 08/03/2026.Vaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: noneAccess to toxins eg. Rodenticide: none EXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: RHS maxillae and mandible have swollen up(oedematous). No discharge.  Looked at 108 and 109 no swelling. - Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: Eating treats PROBLEM LIST:1. Acute, severe facial oedema. DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Suspected severe allergic reaction (localised angioedema/anaphylaxis). DIAGNOSTICS:None ASSESSMENT:  TRA or analyphaxis(hypersensitivity) TREATMENT:  The patient is to be discharged home.- Metacam to be ceased immediately.- Prednisolone tablets dispensed to be started on the evening of Thursday, 13/03/2026. This provides a three-day washout period for the Metacam.- Dosage for prednisolone: one tablet once daily for seven days. 20mg pred- It was discussed that Metacam could be restarted after a 3-day washout period following the completion of the steroid course, which would be from 21/03/2026. PLAN:- Cease Metacam.- Start Prednisolone on the evening of 13/03/2026 as directed.- Continue with scheduled injections as planned if the patient is back to normal.- Monitor closely for the next 12-24 hours.- Home into owner's care. CLIENT COMMUNICATION:Discussed that the likely cause is a severe allergic reaction. The owner was counselled on two treatment options: an immediate start of steroids with concurrent gastro-protectant medications, versus a safer approach of waiting three days after ceasing Metacam before starting steroids. The owner elected the safer option to minimise the risk of side effects like stomach ulcers, especially given the patient's age. Advised that prednisolone may cause side effects. Instructed the owner to monitor for any vomiting, lethargy, or loss of appetite over the next 12-24 hours. If these signs occur, the patient requires immediate re-evaluation, intravenous fluids, and an abdominal ultrasound. The owner was given clear instructions on when to start the steroid medication (evening of 13/03/2026) and when Metacam can be potentially reintroduced (21/03/2026).    Vital Signs    Weight: 37.6;