C10028793 / invoice 10000
Species:CANINE
Breed:German Shepherd
Age (years):7
Diagnosis or signs:EUA of ears and assess for laryngeal paralysis
Consult notes
13/03/2026 Ear/skin recheck + change in bark History: - Owner reports recent change in Freddie’s "chatty" bark dysphonia for approximately 1 week Owner reports prior episode with ulcerations around nose and lips that have cleared; completed a 1-month course of antibiotics finishing this week. History of ear issues managed with an ear medication applied periodically; owner states he requires in-clinic application under heavy sedation at times. Following recent oral biopsy, ear medication was placed while heavily sedated and instructed to return for next dose on the weekend; a vet nurse was unable to administer into one ear at that visit. Since then, owner notes increased head shaking. For handling/anxiety, owner administered trazodone and gabapentin last night and 2 hours before visit to facilitate today’s visit; owner reports this is the minimum needed for cooperation. Owner expresses concern about Freddie’s age (reported as 7 years) and wishes to minimize the number of anaesthetic. Any other concerns: N On any medication: - Apoquel 2x 16mg tablets PO SID - Owner-reported: trazodone 4 tablets this morning; gabapentin 2 capsules/tablets this morning and given last night as well Changes in behaviour: Requires significant pre-visit sedation to allow handling; greedy with treats Changes in eating/drinking: No changes reported Changes in activity levels: N Changes in toileting: No changes reported Routine Health Care: Microchip Checked: Y Vaccinations Up to Date: ? Intestinal Worming Up to Date: ? Heartworm Prevention Up to Date: ? Flea Prevention Up to Date: ? Pet Insurance: Owner reports having insurance that covers a significant portion of costs; specifics not provided. Physical Examination: Brief due to patient temperament Temperature: Not performed Pulse: WNL Respiratory Rate: Panting Blood Pressure: Not performed Body Condition Score /9: 7 Dental Grade: 1 Thoracic auscultation: NSF Abdominal palpation: NSF Eyes: NSF, corneas appear clear and free of discharge, pupils normal size, globes symmetrical OU Ears: Visible medial pinna not markedly erythematous of ceruminous Oral Cavity: No remaining visible ulcerations or lesions around mouth and nose visible today H/Lymph: NSF Skin: NSF, skin appears normal; hair coat in good condition, no ectoparasites noted Musculoskeletal: NSF Urogenital: NSF Neurological: NSF Routine Investigations: Ear cytology attempted with licky mat with kong cheese & liver treats. Freddie would not tolerate swabbing ears conscious today Assessment: - Freddie requires injectable sedation in order for further assessment of ears - Change in vocalisation: suspicious of laryngeal paralysis. As Freddie requires sedation for ear examination and suspicions of laryngeal paralysis, discussed performing ear cytology and layrngeal assessment under deep sedation/twilight anaesthesia. Discussed requirement of thoracic radiographs in addition to laryngeal assessment which will require short GA. Possibility to perform this today but if laryngeal paralysis diagnosed today, surgical intervention would not be able to be performed. O would like to keep number of GAs as short as possible so discussed performing ear examination + laryngeal assessment + thoracic radiographs +/- laryngeal tieback surgery on Tuesday with WF O going away on Friday and will be in care of O's son. O would prefer to wait until they are back for surgery to take place if required O elected to continue with deep sedation/twilight anaesthesia for ear & laryngeal examination. Advised requirement for thoracic radiographs. O declined today and will pursue thoracic radiographs under same GA required for laryngeal tieback surgery if required. Plan: Treatment Provided: - Admission to hospital for ear & laryngeal assessment Follow up plan: - Proceed with deep sedation for otic and laryngeal examination + ear cytology - If laryngeal paralysis diagnosed, O to book in sx when back from Japan trip - If otitis externa diagnosed, treat accordingly - preferably with product with minimal application as possible ie osurnia 13/03/2026 PROCEDURE - Pre Anaesthetic Testing: Pre Anaesthetic Examination: HR CRT MM RR General Anaesthetic: - Premed - - Induction - Intraoperative Fluids: Hartmans @ mph Procedure: Post-operative Instructions: Home care Recommendations: Remind/Recall/Revisit: 1 day - FUC - Reception 3-4 days - POC - nurse 14 days - POC - nurse
Animal clinical history (3 most recent)
2026-03-11T00:00:00Z 09:45:11
Follow Up Call: HOW IS FREDDIE DOING SINCE STARTING CEPHALEXIN? - Freddie is doing well - The medication worked very well - Seemed to clear up after a week and has been doing very well since - Booked in on Friday morning for an ear and mouth check with a vet
2026-02-09T00:00:00Z 11:05:53
HISTOPATHOLOGY RESULTS SKIN_PUNCH Clinical History: Severe skin ulcerations on both lower lateral lips, upper rostral lips and corners of alar folds. Freddie is on apoquel for skin allergy issues. Concerns about auto-immune disorders (eg pemphigus). Pathology Report INTERPRETATION: Dermatitis, plasmacytic and neutrophilic, extensive, moderate, chronic, with pigmentary incontinence and multifocal ulceration COMMENTS: Histopathological examination of the skin/mucocutaneous junction biopsies revealed chronic plasmacytic dermatitis associated with multifocal ulceration and neutrophilic inflammation. The changes are compatible with a chronic inflammatory process. Dermatitis of this nature is usually a nonspecific response to chronic antigenic stimulation. In this location, the major consideration is mucocutaneous pyoderma (antibiotic responsive dermatitis). This condition typically affects the lips and perioral skin, however, the nasal planum, prepuce, periocular and perianal regions may be affected. The German Shepherd dog may be at an increased risk. Prolonged antibiotic therapy is typically required for complete resolution. There was no evidence of basal cell degeneration, apoptosis or single cell necrosis, features diagnostic for discoid lupus erythematosus. Additionally, the predominance of plasmacytic inflammatory infiltrates in this case is more typical of mucocutaneous pyoderma relative to discoid lupus erythematosus. In some cases, mucocutaneous pyoderma may be indistinguishable histologically with discoid lupus erythematosus, therefore, true distinction should be based upon an observed response to a 3-4 week regime of appropriate antibiotic therapy. No features of pemphigus are identified. There are areas of ulceration with neutrophilic inflammation, suggesting a possible secondary pyoderma. Although no bacteria was seen with Gram stain, these are not always captured in histological section. Scattered eosinophils are noted which is a nonspecific finding but can be seen with hypersensitivity reactions. HISTOPATHOLOGIC DESCRIPTION: Multifocally, there is a thin to moderate serocellular crust containing entrapped viable and degenerate neutrophils, keratinaceous debris and serum protein. In several regions, neutrophils are transmigrating through the epithelium and associated with transepithelial spongiosis and there is patchy pigmentary incontinence. Diffusely, the epithelium is moderately to markedly hyperplastic with minimal orthokeratotic and parakeratotic hyperkeratosis. Within the superficial submucosa/dermis, closely approximated to but not obscuring the dermal/epidermal interface, there are large numbers of mature plasma cells and lesser numbers of small mature lymphocytes, eosinophils and neutrophils, apart from the ulcerated areas with neutrophilic inflammation is common. Inflammation extends around cutaneous adnexa. No bacteria or fungi are identified with gram and PAS stains. PLAN Called Freddie's Mum with results Happy to start extended antibiotic course- Cephalexin 1000mg PO BID q 28 days (56 tabs) Freddie is doing a bit better but still licking around the lip region We discussed topical mucpiricin- he gets stressed with topical applications and likely to lick it off Explained in some cases can still require prednisolone- however, as he is currently on long term Apoquel to manage pruritus, we will start with antibiotic course initially Freddie has still been irritated by his ear- O to book for morning appointment next week for ear exam, will have Gaba and Traz onboard but likely to require additional sedation for exam + Osurnia application Recheck at end of 4 week course
2026-02-04T00:00:00Z 19:39:18
- O called to cancel appointment for 5.2.26 as patient ate some chicken and rice - Will monitor his condition and call to update - ST 4.2.26
Previous claim history (7)
| Date | Claim # | Diagnosis |
|---|---|---|
| 2026-01-28 | C09821162 | PYODERMA - LIP FOLD |
| 2026-01-28 | C09821162 | DIARROHEA |
| 2026-01-28 | C09821162 | HYPERSENSITIVITY (ALLERGIC) SKIN DISORDER |
| 2023-03-17 | C5699434 | EAR INFECTION |
| 2023-03-07 | C5657476 | EAR (AURAL) INFECTION |
| 2023-03-06 | C5655880 | EAR INFECTION |
| 2023-03-06 | C5699446 | EAR INFECTION |
Line items(lines with upstream diagnosis are skipped by the model)
| Line | tstarc | Amount | Date | Upstream diagnosis |
|---|---|---|---|---|
| 10000 | tstarc_consultation | 104.50 | 2026-03-13 | — |
| 20000 | tstarc_procedure_fee | 89.00 | 2026-03-13 | — |
| 30000 | tstarc_hospitalisation | 88.95 | 2026-03-13 | — |
| 40000 | tstarc_sedation_for_procedure | 240.25 | 2026-03-13 | — |
| 50000 | tstarc_anaesthesia_-_monitoring | 35.80 | 2026-03-13 | — |
| 60000 | tstarc_iv_catheterisation | 53.10 | 2026-03-13 | — |
| 70000 | tstarc_diagnostic_test_-_cytology | 72.12 | 2026-03-13 | — |
UPM+
- DG00676EAR (AURAL) INFECTIONDSTP_otitis_externa
Variant (sleepy_king)
DERMATITIS
DSTP_skin_-_dermatitis
Conf: 0.470
Threshold: 0.25
Above: ✓
Correct?
Acceptable?
Reason (not acceptable — misleading)
Diagnosis description