C10014395 / invoice 10000

VNG recommendation = continue with kangaroo, pumpkin, zucchini, blueberries and spinach as that will make it a moderate fibre diet. can try that first. if still showing signs of large bowel diarrhoea can add more fibre. can use sweet potato with skin instead of pumpkin or can add psyllium. to do ACTH stim to rule out addisons. to do diet trial for 3 weeks and then recheck. if not improving recommend booking abdominal u/s and endoscopy biopsy given CCECAI. Following diet, still on lead, poo still on the soft side with no mucous, twice a day, no vomitsate last night, refused food this am, less than excited 3d walkingEXAMINATION: Demeanour: BAR MM: Pink, moist, CRT <2 Eyes: Clean and clear, normal eyelids, no erythema or discharge Ears: L ear some discharge along ventral canal but no swelling and only sl inflammationR ear: very red, increased discharge and some swelling of the canal Lymph nodes: Peripheral lymph nodes palpably normal Oral: No oral lesions or abnormalities detectedTeeth: Dental grade 0/4, normal occlusion. COHAT Level Estimated: (A, B, C, D, E) Cardiovascular: Normal heart sounds, no murmurs or arrhythmias detected, femoral pulses synchronous and normodynamic Respiratory: No nasal discharge, normal bronchovesicular lung sounds in all 4 quadrants, no coughing seen Abdomen: Soft and comfortable on palpation, no masses palpated, bladder unremarkable MSK: Normal gait no lameness. Normal ROM with no pain of all limbs. No pain on DV palpation of spine Integument: Coat is soft and clean, no ectoparasites detected, no obvious skin lesions or masses Neurological: Normal mentation, no ataxia or CP deficits observed. Full exam not performed Reproductive/Urogenital: External genitalia normal in appearance Rectal: Not performed PROBLEM LIST: otitis externa bilat, increased gut sounds without increased temp or painDIAGNOSTICS: L ear: few yeastR ear: yeast ++ and inflam cells ASSESSMENT/DDX: PLAN:1. o going away 10d from tomorrow and will do u/s and scope at Sash when returns2. Tx ears dermotic3. r/v ears 2 weeksMEDICATION: dermotic for earsCLIENT COMMUNICATION: discussed use of anti-nausea like prevomax and O will wait and see how he is tonightTREATMENT: dermotic ears bid 10d then r/v 14dHandouts given: Health report / Dental / Arthritis / Other (Name)Estimate provided (Y/N or NA)Shaking head, pawing at ear/s (/Right) Red, swollen, painful ear/s (Y)Discharge from the ears (Y)Previous ear infections (Y/N)Concurrent skin problems (/N) EXAMINATION: Demeanour: BAR MM: Pink, moist, CRT <2 Eyes: Clean and clear, normal eyelids, no erythema or discharge Ears:External appearance: (bilateral brown discharge, erythematous) Otoscope exam: (brown discharge, canal swelling, TMs intact/not visible)Lymph nodes: Peripheral lymph nodes palpably normal Oral: No oral lesions or abnormalities detectedTeeth: Dental grade 0/4, normal occlusion. COHAT Level Estimated: (A, B, C, D, E) Cardiovascular: Normal heart sounds, no murmurs or arrhythmias detected, femoral pulses synchronous and normodynamic Respiratory: No nasal discharge, normal bronchovesicular lung sounds in all 4 quadrants, no coughing seen Abdomen: Soft and comfortable on palpation, no masses palpated, bladder unremarkable MSK: Normal gait no lameness. Normal ROM with no pain of all limbs. No pain on DV palpation of spine Integument: Coat is soft and clean, no ectoparasites detected, no obvious skin lesions or masses Neurological: Normal mentation, no ataxia or CP deficits observed. Full exam not performed Reproductive/Urogenital: External genitalia normal in appearance Rectal: Not performed PROBLEM LIST: N/A DIAGNOSTICS: Cytology:Left ear: ( ) Right ear: ( ) ASSESSMENT/DDX: Otitis externa (L ear/R ear/both ears) Infection type (Bacterial/Malassezia/Mixed) PLAN:MEDICATION: Owner shown how to administer CLIENT COMMUNICATION: Explained importance of recheckExplained prevention/home maintenance requiredTREATMENT: Handouts given: Ear infections Top 10 handout Progress exam booked Verified: YESHISTORYPresenting for: Obi presented for decreased appetite and lethargy over the past 2-3 days, with the owner noting he was not eating this morning and appeared fatigued and lying down more than usual.Historical Conditions:- Chronic gastrointestinal issues with ongoing investigation including previous blood work, faecal examinations, and dietary trials- Currently working with veterinary nutritionist Ingrid on dietary management- Previous B12 supplementation (now discontinued as levels were in normal range)- ACTH stimulation test results were normal- Recent faecal float examination on 6th (normal)- Titre test sent 13 days ago (results pending)Diet:- Following veterinary nutritionist recommendations under Ingrid's guidance- Currently on 2-week dietary trial- Appetite decreased over past 2-3 days, not eating this morning- Ate normally last nightV/D/C/S:- Faeces slightly soft but no mucous, significantly improved from previous episodes- Defaecating twice daily- No vomiting reportedCurrent Meds:- Ear cleaning solution (wash) used SundayEXAMMentation: BART: 38.3°CHR: NormalMM: Slightly pale but good capillary refill time, moistHydration: Not dehydratedBehavioural: More subdued than usual, allowing examination procedures he would normally resistEars: Left ear - some discharge along ventral canal, no swelling, slight inflammation. Right ear - very red, increased discharge, some swelling, inflamedCardiovascular: Heart sounds normal, good pulseAbdominal: Hyperactive gut sounds described as washing machine noise, no pain on palpationDiagnostics: Ear cytology - Left ear: few Malassezia organisms. Right ear: Malassezia plus plus with white blood cells presentASSESSMENTOtitis externa - Bilateral yeast infection with right ear more severely affected than left based on cytology findingsIncreased gut motility - Hyperactive intestinal sounds without fever or abdominal pain, likely related to ongoing chronic gastrointestinal conditionPLANNew Meds/Tx:- Surolan otic drops: 1ml each ear twice daily for 10 daysAdditional Discussion:- Discussed option of Cerenia injection or tablets for nausea management if appetite does not improve- Owner travelling for 10 days starting tomorrow- Discussed referral to SASH for internal medicine specialist consultation and possible endoscopy/ultrasound when owner returns- Ear recheck appointment in 2 weeks- Owner to monitor appetite and contact clinic if condition worsens while away    Vital Signs    Weight: 34.8;       MMColour: Pink;       HeartRate: 100;       Temperature: 38.3;       BodyScore: 5;       CRT: 1-2;