C10010406 / invoice 10000

10/03/2026 Reason: X-ray imaging 

Diagnostic imaging: 
Conscious lateral and VD thoracic images taken
Cardiac silhouette subjectively enlarged/D shaped
Intermittent alveolar pattern? 
No obvious narrowing of trachea 

Anaesthesia:
ACP (0.02mg/kg) + Butorphanol (0.2mg/kg) IV
Induction: Propofol only to effect

Non-surgical treatment:
Otoscopic exam of nasal passages - no FB, no rhinitis etc
Examination of larynx unremarkable, no thickening, no paralysis, tonsils nad

Plan:
Recommend submitting radiographs for interpretation
Await results
Next steps consider scoping (broncho vs gastric given mild regurg)

10/03/2026 History:
- Presented for a persistent cough that has been present for approximately three months. The cough has gradually worsened in that time. The character of the cough has changed from a standard cough to a whistle-like sound.
- The cough occurs at night, waking the owner, and can also be triggered by eating treats. The owner notes a terminal retch at the end of coughing episodes. The frequency has increased slightly. The noise appears to be of upper respiratory origin.
- Exercise tolerance is reportedly okay, but has decreased from when younger. No increased respiratory effort noted by the owner at home.
- Recently seen by KW on 23/02/2026 who suspected an upper airway cough and trialled doxycycline with no significant improvement.

Past Medical History:
- Grade 5/6 heart murmur. Cardiac check-up earlier this year showed stage B2 mitral valve disease with no signs of congestive heart failure.
- Sudden hearing loss in September 2025.
- Mild hip osteoarthritis.
- General anaesthetic for ear cleaning and treatment on 08/10/2025.
- AES for rat bite on 16/06/2023.
- Back pain and pruritis in December 2022.
- Suspected bite on left ear on 01/09/2022.
- General anaesthetic for torn right fore dew claw on 17/02/22.
- Pimobendan 2.5mg, three-quarters of a tablet once daily. Last dose was this morning.
- UTD.

Physical Examination:
- Heart rate 100 bpm, regular rhythm. Murmur present 
- Resting respiratory rate at home was previously 19 breaths/min.
- General: Bright and alert in consult. Appears stressed-pants a bit . No obvious increase in respiratory effort observed.
- Cardiovascular: Grade 5/6 heart murmur auscultated. No other abnormal heart sounds.
- Respiratory: No obvious abnormalities on thoracic auscultation in clinic. Noise appears to be of upper respiratory origin.
- Oropharyngeal: Full examination deferred as Scruffy is resistant to handling.

Investigations:
- Pre-anaesthetic bloods (25/09/2025): Mild stress hyperglycaemia noted. All other parameters within normal limits.

Impression & Plan:
1. Worsening Upper Airway Cough
- The change in the nature of the cough is suspicious for an upper airway issue rather than a primary cardiac or lower respiratory cause.
- Pharyngeal irritation/inflammation
- Enlarged tonsils
- Laryngeal disease (e.g. mass, cartilage abnormality)
- Dental disease causing secondary inflammation
- Bronchitis
- Discussed the need for a thorough examination under anaesthesia to visualise the pharynx, larynx, and oral cavity, as this cannot be performed adequately while conscious.
- Advised owner of the small but present anaesthetic risk associated with his cardiac disease, but that investigation is necessary to diagnose the cause of the worsening cough. 
-An estimate of costs was provided (approx. $1100-1200), with the potential for this to increase if a dental procedure or other interventions are required.
- The owner has insurance and consented to proceed. Dr Cassie will be performing the procedure.
- Admit today for general anaesthesia.
- Repeat pre-anaesthetic blood screen.
- Full oropharyngeal, dental, and upper airway examination.
- Thoracic radiography (3 views: right lateral, left lateral, dorsoventral).
- Will be based on findings.
- Will clip nails while under anaesthesia as requested by the owner.

PLAN:
- Scruffy will be admitted today for an anaesthetic procedure to investigate his cough.
- The plan includes a blood test, chest x-rays, and a full examination of his mouth and throat.
- Dr Cassie will be performing the procedure and will contact you later today with an update.

+++handover to surgery team ++++