C10009212 / invoice 10000

Reason: EchoAppointment Notes: Overdue remindersRecord Entered by: Record Checked by:Bam Bam is a 13y6mo MN Lhasa Apso x that has presented for echocardiogram. Weight: 6.5BCS: 7/9Temperature: 38.9Heart Rate: 84, grade III murmur.Pulse Rate and quality: Strong and synchronous Mucous Membranes: PinkCRT: 1-2secsLymph Nodes: L pre-scapular lymph node enlargement Other findings: Assessment:- MMVD Stage B1 with tricuspid regurgitationPlan:- Pending cardiologist review    Vital Signs    

Reason: RM - EchoIgnore visit - for billing purposes    Vital Signs    

Record entered by: DVM studentRecord checked by: MZBam Bam is a 13y5mo MN Lhasa Apso that has been presented to the University Veterinary Teaching Hospital Sydney Referral Medicine service on the 9/3/2026 for acute coughing. Specific history: Bam Bam first presented for coughing on the 4/3/2026 (<24h history) to UVTHS ECC. The coughing is described as harsh, deep, and consistently accompanied by a terminal retch. It occurs multiple times throughout the day, and each episode will have around three coughs each. During these episodes he will stop whatever he is doing, then after the coughing, he will resume as previous. He was dispensed Codeine (1mg/kg PO) previously which did not make a difference to his coughing. The O also reports a metallic smell from Bam Bam's mouth, which is a new finding.Pertinent history:December 2025: Neck pain, prayer position, lethargy and inappetance requiring hospitalisation. Discharged with gabapentin 100 mg, ondansetron 4mg q8-12 hrs and has not recurred since. April 2025: Coughing episode in April. Resolved with meloxicam.2021: Hypothyroidism diagnosed. Managed now with thyroxine at 200 mcg PO SID.  2019: tonsillar SCC with L submandibular LN metastases diagnosed at SASH. Surgical excision of the tonsil, retropharyngeal LN and submandibular LN with radiation therapy. Managed now with chlorambucil 0.5 mg/kg: 2 mg tablet q8.Other history - bilateral MPLsMedications: - Chlorambucil 2mg PO SID (Monday to Friday only)- Levothyroixine 200mcg PO SID @ 7pm Physical examination:SUBJECTIVE BAROBJECTIVEBWT = 6.3 kg; BCS = 7/9VITALS: HR = 96 PR = 96; RR = 28 bpm; MM = pink CRT 1-2s, moist; T = 37.4 periph T = warmCVS: murmurs = grade III/VI systolic PMI L apex; arrhythmia = nil; pulses = femoral pulses present and synchronous with HR. Blood pressure = not taken.RESP: normal bronchovesicular sounds in all lung fields, normal respiratory effort and pattern. No tracheal sensitivity.GIT:ORAL CAVITY: Grade IV periodontal disease with calculus on both upper and lower arcade. Marked hallitosis.ABDOMINAL PALPATION: no palpable abnormalities or painRECTAL EXAM: not performed/normal anal tone. No faeces palpated in rectum. No blood.UROGENITAL: NAD, no discomfort over palpation of the kidneys. Urinary bladder small and comfortable.NEURO: NAD, appropriate mentation, ambulating with appropriate posture with no vestibular signs, a full neurological examination was not performed.M/SKEL: palpable bilateral MPL (L worse than R), ambulatory, no muscle asymmetry, full MSK exam not performed.INTEG: firm, well demarcated, mass ~ 5cm adjjacent to the L prescapular lymph node, no alopecia, no ectoparasites, skin turgor normal.OTIC: NAD, no erythema, no discharge, not malodorous. A full otic examination was not performed.OCULAR: NAD, visual, no discharge or epiphora bilaterally, no blepharospasm, no anisocoria, conjunctiva was non-inflamed bilaterally.NASAL: no crusting or ulceration of the nasal planum, no overt discharge, nose moist.PERIPHERAL LN: palpably normal shape, size and texture.NB: Bam Bam was frequently gulping and lip smacking during PE. VPDS FNA of 5cm mass adjacent to L prescapular LN Adipose tissue consistent with lipoma.VPDS CBCNeutrophils-seg 9.35 (1.53-8.55) Smear - moderate number of neutrophils with mild toxic changeVPDS MBAAmylase 1644 (377-1220)Lipase 1127 (17-226)ALP 258 (0-94)ALT 120 (10-95)CRP 45 (0-10.7)TT4 34.1 (12-41)Vetnostics Vitamin B12 PENDINGProblem list:- Acute, persistent, honking cough - Previous dx with tonsillar squamous cell carcinoma (ongoing medical management with Chlorambucil)- Hypothyroidism (controlled with levothyroxine)- Grade 3/6 heart murmur -> MMVD - Grade ? dental disease- High BCS- Bilateral MPLs (L worse than R)- Mild neutrophilia with toxic change on smear- Mild ALT and ALP elevations- Mild CRP elevationsAssessment: Bam Bam's acute coughing is likely secondary to either a degenerative upper respiratory tract disease, such as tracheal collapse or bronchomalacia vs gastrointestinal disease ie., gastroesophageal reflux with the lip smacking/gulping observed in consultation (ddx dysphagia, fistula). Other upper/lower respiratory tract disease include canine respiratory disease complex, inflammation (eg., bronchitis, pneumonia), allergic disease (eg., eosinophilic bronchopneumopathy), neoplastic (eg., laryngeal, tracheal, pulmonary, mediastinal), and parasitic or fungal infections (less likely given geographical region and signalment). Cardiovascular causes are also possible including cardiomegaly/left atrial enlargement, cardiogenic edema (less likely based on thoracic auscultation), PTE. The history of tonsillar squamous cell carcinoma raises concerns for a neoplastic process underpinning the cough; although, they might be unrelated. The neutrophils displaying toxic chanage + mild C-reactive protein elevatios are non-specific for inflammation (either infectious or non-infectious). The mild ALT elevations can be secondary to hepatic disease (degenerative, inflammation [infectious v non-infectious], neoplastic). The ALP elevation can similarly be secondary to hepatobiliary disease (eg., as before + cholestasis), gastrointestinal disease, hyperadrenocorticism, non-hepatic neoplasia.Plan:- Monitor coughing, respiration, mentation, appetite, thirst, urination, defecation- Vitamin B12 pending- Echocardiogram with All Hearts tomorrow. Options moving forward presented to the owner includes (beyond echocardiogram): 1. Fluoroscopy + CT 3 region w/contrast (head/chest/abdomen) + bronchoscopy (+ oesophagoscopy and posterior rhinoscopy) + BAL (cytology/culture) +/- resting cortisol 2. Fluoroscopy + treatment trial for GERD with metoclopramide and dietary change to Purina HAO would like to consider options before pursuing further investigations. A written summary has been forwarded.    Vital Signs