C10032134 / invoice 10000

Verified: YESClient: HollyHistory: Post-operative recheck. Previously had dental extractions (2 teeth) approx 2 weeks ago. Doing well post-operatively, was given antibiotics last visit for 304 tooth (food/infection in socket). Able to give meds alright, no concerns today.Exam:Mentation: BAR, nice boyCardio: HR = 90, no murmur or arrythmiaResp: RR = panting, stertor presentEyes: Clear, no reddening or dischargeEars: Clear, no reddening or dischargeTeeth: Gde 0/4Other oral exam: 304 extraction site - loose suture and food in socket, flushed and food removed in consult, no erythema or swelling present, one suture still in place. 201 extraction looking greatMM/CRT: pink/moist, CRT<2sRectal: Did not perform rectal examAssessment:Extraction sites healing well - food/sutures flushed from socket but no erythema or swelling present.Plan:Diagnostics: n/aTreatment: NADRecommendations & Client Comms: Continue to monitor mouth, revisit if any concerns. Discussed dental care and gave dental treatsRecheck: No11/02 NCB MS - 14d post dental check, NCB unneccesary

Verified: YESClient: Edward and HollyHx: In for POC, doing well, eating drinking fine. Was a little groggy the first night but now back to normal. On loxicom, last dose last night. No vomiting. On wet food.PE: BAR, eyes ears ok, mm pink moist, 304 extraction site sutures broken down, open socket with food material inside and smells + . Incisor site nad. HR lungs nad, large stertor noise associated with breed. Nares barely open.Plan: amoxyclav 250mg BID to prevent post op infectioncontinue loxi SID for another 3-4 daysPOC with vet in 1 weekNo AI as was already in room and computer not on and had been waiting a while*01/02/2026 - NCB/AFH - no ncb as POC

Verified: YesHISTORYPresenting for: Grade 4 dental disease with fractured tooth 304 and dental pulp exposure. Mobile fractured tooth 201 and 402. Also very concerned re: BOAS.EXAMMentation: BARRespiratory: Obvious brachycephalic obstructive airway syndrome (BOAS) with stridor and increased respiratory effort. Hyperventilation +++Oral: Tooth 304 fractured with pulp exposure. Tooth 201 fractured and very mobile. Most lower incisors still under gum margin with one protruding (suspected to be 402). Tooth 303 NAD. Tooth 305 has root under gum margin not causing irritation.Diagnostics: Dental radiographs confirmed presence of lower incisor teeth under gum margin.ASSESSMENTDental disease - Grade 4 with fractured teeth (304, 201) requiring extractionBrachycephalic obstructive airway syndrome (BOAS) - Significant respiratory compromise requiring specialist referral for surgical management - Owners to look at this ASAPPLANMedications/Treatments:- Pre-medication: 0.04mL methotomidine and 0.43mL methanolone IM- Induction: Alfaxan- Maintenance: Alfaxan top-ups plus isoflurane and oxygen- Preoxygenation performed prior to anaesthesia due to BOAS- Surgical extraction of tooth 304, suture closed with 4-0 monocryl- Surgical extraction of tooth 201- Extraction of protruding lower incisor (suspected 402) - closed with 2/0 monocryl- Attempted to locate other lower incisors visible on radiographs but unable to visualise and no irritation of gum irritation- Scaling and polishing of all remaining teeth- During recovery: severe hyperventilation noted, treated with 0.04mL Domitor IV without effect, followed by 1.2mL Propofol IV which was effective initally but hyperventilation returned- Naloxone 0.8mls IV - Enzo immediately woke up, and hyperventilation stopped- Vomited - bringing up a lot of food from stomach - thick slabs of meat and kibble.- 1.7mls Maropitant IV- Constant SPO2 and hands on monitoring until patient conscious and breathing well- IV paracetamol given 17mls IV due to lack of opioidAdditional Discussion:- Significant concerns about BOAS and respiratory compromise- Referral to specialist for airway surgery strongly recommendedClient Comms:- Discussed concerns about patient's well-being without surgical intervention for BOAS- Recommended specialist referral for discussion about airway surgeryNL discharge with both owners- Went through x-rays and photos- Bloods provided- discussed opioid hypersensitivity- Discussed desexing and BOAS surgery- Advised has a very wide neck due to still being intact- Advised weight loss- Soft food feeding for the next 10-14 daysTaken to reception for 3 and 14 vet POC28/1 - Doing well, was a little sleepy. Ate a small amount of food this morning but not alot. No vomitting or diar. O going home at lunch time so will call if any concerns or not eating today mc