C10025337 / invoice 10000

Consult Time: Triage - 2241   consult - 2359History:- C/O recurrent otitis, recently restarted tonight. The owner reports the right ear appears more affected, with head tilting to the right and head shaking observed.- C/O perianal irritation with associated licking for the last 2-3/7. The perianal area is reported to be red.- The owner reports a history of intermittent otitis, which typically resolves with surolan treatment but subsequently recurs. No surolan has been administered for this current episode. The last administration was approximately 10/7 ago.- The paws are also reported to have some redness- Reported unusual discomfort and agitation during rectal temperature measurement at today's visit.- The owner notes that the brother, Campbell, presented to an emergency centre on Saturday night with suspected diarrhoea. Baxter's stools have been observed with some mucus tonight, but no signs of haemorrhagic diarrhoea, which has been a previous issue - Diet tonight consisted of pumpkin, rice, and a small amount of chicken for both dog's in light of brother's d+- Hx of undiagnosed allergic skin conditions.- Recent treatment with Apoquel and an unspecified antibiotic for approximately 15/7, commencing 20/02/2026.- Hx of perianal lipoma removal in April 2020 with clear margins confirmed on cytology.- Hx of multiple lipomas.- Hx of septicaemia following a previous excision procedure, which required a 5-night hospital stay.- Grooming, including anal gland expression, was performed approximately 2/52 ago. The groomer reported that nothing was expressed from the anal glands at that time.Objective:HR 120, RR panting, mm pink, moist, CRT 1.5 sec, tep 39.1- Ears: Grossly, ears do not appear significantly inflamed. The right ear shows some pinkness at the edges of the cartilage. The left ear has more debris and wax than the right. Otoscopic examination of the left ear reveals small red inflammatory spots.- Perianal: The anus and the area extending to the base of the tail are pink and inflamed, consistent with licking, chewing, or scooting. The right anal sac is palpably full and firm with no give, while the left anal sac is WNL. Attempted manual expression of the right anal sac was unsuccessful and painful to attempt - possibly impacted or not actually AG, possibly mass or hard cyst- Eyes: Bilateral lenticular sclerosis noted, appearing denser in the left eye. The retinae appear grossly normal. Vision appears to be present, though depth perception and focus are likely affected.- Diagnostics:- Ear Cytology (Right Ear): Mild to moderate Malassezia growth. No visible bacteria. Debris and skin cells (squames) present.- Ear Cytology (Left Ear): Similar to the right ear with squames and yeast present. No visible bacteria or inflammatory cells. A greater number of yeast organisms are present compared to the right ear.- All other organ systems normal.Assessment & Plan:1. Bilateral Otitis Externa- Assessment: Malassezia overgrowth.- Treatment planned: Commence Suralan in both ears. Owner has enough for tonight, to get new bottle at GP tomorrow. Apoquel may be considered if generalised pruritus develops, but is not indicated for the current localised issues.2. Perianal Irritation / Anal Sacculitis- Assessment: Anal sacculitis / Impaction (Right).- Differential diagnosis: Perianal mass, allergic dermatitis.- Investigations planned: Monitor for continued scooting or discomfort. If symptoms persist, consider sedation or anaesthesia for flushing of the right anal sac.- Treatment planned: Topical Neocort applied to the inflamed perianal skin to provide local anaesthetic and anti-inflammatory effects.3. Lenticular Sclerosis- Assessment: Age-related lenticular sclerosis.- Treatment planned: Owner counselled on the nature of the condition, its slow progression, and potential impact on vision (e.g., depth perception, adaptation to environmental changes). Advised on potential complications such as lens luxation and secondary glaucoma, although these are not present currently. No immediate intervention required.Treatment:None administered in clinic.    Vital Signs    Weight: 18.1;