Summary of Chief's visit on 07/17/2025

Doctor: Justin Hanson, DVM

Tech: Renton Clinic

Assistant: Jenifer Gonzalez

Client

Dan Wheeler

(206) 387-7127

dan@quizkid.net

Patient

Chief

15 years

Neutered male

Discharge notes

Presenting Complaint: Chief, a 15 years Neutered Male Mixed breed (Dog), presented to BoosterPet Urgent Care on 07/17/2025 for anual exam and head shaking.

Physical Exam:

Mentation: Quiet, alert and responsive.

Hydration: Euhydrated

MM: Pink and moist

CRT: < 2 secs.

Body Condition Score: 7/9

Cardiovascular: No murmur or arrhythmia on auscultation, femoral pulses strong and synchronous

Respiratory: Eupneic with clear bronchovesicular sounds in all lung fields. No crackles or wheezes

Neurologic: Mentally appropriate, cranial nerves intact. Full neuro exam not performed

EENT: Clear corneas, no ocular or nasal discharge. Severe purulent discharge and erythema AD, mild debris and erythema AS, moderate periodontal disease - Grade 3/4

Gastrointestinal: Abdomen was extremely firm on palpation. No overt organomegaly noted

Urogenital: Externally normal neutered male. No redness or discharge.

Dermatologic: There is a lobulated, pink, dermal mass measuring approximately 3cm in diameter on the external pinna of the left ear. There is a large, soft, subcutaneous mass measuring approximately 10cm in diameter on the right side of the penis. There is generalized alopecia and seborrhea present. Multiple other smaller dermal and subcutaneous masses present throughout the trunk and limbs.

Musculoskeletal: Ambulatory x4, Adequate muscling, full orthopedic exam not performed

Lymph Nodes: Popliteal lymph nodes were bilaterally enlarged (approximately 1-1.5cm in diameter.

Plan

Diagnostics:

- In-house ear cytology: AS- Mild waxy debris, no other significant findings; AD- TNTC rods and cocci

- SA720 Senior Profile bloodwork and urine: Declined

- aFAST: There was a large heterogenous mass-like structure present in the mid abdomen

- Single right lateral radiograph: There was a large, round mass present in the mid abdomen that was displacing the intestines ventrally and dorsally. Mass could be originating from the liver or spleen.

Treatment:

- Cleaning and flushing ears with ear cleaning solution

Problem list:

- Otitis externa AD

Medications prescribed:

Mometamax: Please instill a gentle squeeze (4-8 drops) into the right ear every 12 hours for 7 days. Topical ear antibiotic and antifungal. Discontinue if you notice a head tilt or circling.

TrizUltra+Keto: Please clean the ears every 2-3 days for the next 2 weeks. To clean the ears instill a gentle squeeze into both ears, massage their bases, and allow him to shake his head. Then gentle clean the ears with cotton balls. On days when you clean the ears and administer the Mometamax, please clean the ears first, allow them to dry for 10-15 minutes, then administer the Mometamax.

Rx: Codeine 60mg Tablets: Please administer 1 tablet by mouth every 8-12 hours as needed for pain/discomfort. This is an opiate used for pain control. Potential side effects include sedation, urine retention, constipation, and GI upset. If you notice any of these signs, stop the medication and call your veterinarian.

Medications you have at home:

Gabapentin 300mg Capsules: Please administer 1-2 capsules by mouth every 8-12 hours as needed for pain/discomfort. This is a pain medication that is effective at treating neuropathic pain. The most common side effect is excessive sedation and a wobbly gait.

Prednisone 20mg Tablets: Please administer 2 tablets by mouth every 24 hours for 14 days, then decrease to 1 tablet by mouth every 24 hours for maintenance. Do not abruptly stop this medication. This is a steroid used to decrease inflammation. Please administer with food. Side-effects of this medication include increased drinking and urination frequency, weight gain, and at higher doses can cause GI erosion, ulceration, and even perforation are possible. Do not use this medication with other steroids or with NSAIDs (such as Rimadyl/carprofen, Deramaxx, aspirin, Previcoxx, etc ) as it can cause GI erosion, ulceration, and perforation.

Case summary:

Based on exam and diagnostics, Chief has an ear infection. We have cleaned out the ears and will plan to start treatment with an antibiotic and antifungal ear ointment. Please plan to follow up with your primary care veterinarian in 1 week to recheck the ears to determine if the infection is resolving or if any additional treatment is required.

Ear infections in dogs are primarily due to allergies. Consider a conversation with your veterinarian about ways to manage allergies (Apoquel, Cytopoint, etc.) if he has ongoing ear infections, is licking his feet or itching at his skin.

Based on diagnostics, Chief likely has a malignant cancer that appears to have spread throughout the body. More diagnostics to try to identify the type of cancer in order to potentially pursue chemotherapy were discussed but declined at this time due to poor quality of life. Unfortunately prognosis is grave at this time and you are taking Chief home for palliative care. We discussed starting Chief on pain and anti-inflammatory medications to aid in his comfort level at home. If you notice that Chief is acting uncomfortable, please plan to start using the Gabapentin, Codeine, and Prednisone to aid in his comfort level at home. If you have any concerns, please have him evaluated by a veterinarian. As we discussed, we are unsure of the type of cancer that Chief has, so we cannot accurately predict how long Chief has left.

Diet: Please encourage Chief to eat by offering tasty options, such as canned food, cooked plain chicken and white rice, cottage cheese, plain yogurt, cooked eggs, or low sodium lunch meat.

At home care:

Your pet should wear an e-collar at all times until infection is resolved (~1 week). If allowed to scratch at the ears, it could significantly delay healing and predispose to complications such as an aural hematoma.

Aural hematoma information: https://www.acvs.org/small-animal/aural-hematoma#:~:text=Overview%3A,of%20the%20external%20ear%20canal).

Please continue to monitor Chief's quality of life at home. If he stops eating/drinking, becomes lethargic, develops vomiting or diarrhea, collapses, has pale mucous membranes (gums) or you have any other concerns, please have him evaluated with a 24/7 emergency hospital. If you notice that Chief's quality of life at home is declining and you would like to elect for humane euthanasia, you have have this done at our BoosterPet location, just call ahead to schedule an appointment. Additional options include humane euthanasia at a 24/7 emergency hospital or at-home euthanasia with services such as “Lap of Love”.

Recheck:

- Please plan to follow up with your primary care veterinarian in 1 week to recheck the ears to determine if the infection is resolving or if any additional treatment is required.

-If Chief shows the following symptoms: holding head to the side, circling or vomiting, signs of deafness (loss of hearing), please discontinue ear medication and contact your primary veterinarian or Booster Pet Urgent care immediately. Discontinue medication and schedule recheck exam sooner.

We have treated your pet through our BoosterPet Urgent Care service at this time, but we are not a replacement as your pet's primary care provider. Please plan to return to your primary care veterinarian or establish care with a primary care veterinarian for any further follow-up care, unless otherwise specified (i.e. going to a 24/7 ER hospital due to more critical condition).

Prescribed

TrizULTRA+KETO | Flush 4oz

Dispense: 1 Bottle | Drug expiration: 07/17/26

Instructions

Route: Into the ear

Administration notes: Clean Chief's ears every 2-3 days for the next 2 weeks, then as needed. To clean his ears, instill a gentle squeeze into both ears and massage them at the base. Allow him to shake his head and gently clean the ears with cotton balls. Clean the ears after bathing or swimming.

Mometamax | 15gm bottle

Dispense: 1 Bottle | Drug expiration: 07/17/26

Instructions

Administration notes: Please instill a gentle squeeze (4-8 drops) into the right ear every 12 hours for 7 days. Please clean the ears every 2-3 days for the next 2 weeks. Clean ears before treating.

Details from Chief's visit

Plan

Medical notes

Chief, a 15 years Neutered Male Mixed breed (Dog), presented to BoosterPet on Thursday 07/17/2025 for VCPR Annual Exam.

History:

Chief was originally owned by the current owner's son and was recently adopted by the current owner around 3 weeks ago. Chief has been doing better over the last 3 weeks with increased appetite and activity level, but he has been shaking his head frequently. The owner has noticed a mass on his left ear that has begun to grow in size over the last 3 days or so. Chief is otherwise doing well at home and the owner would just like to ensure he is comfortable at home.

Patient is e/d fine. Energy has improved now being at current owners house.

No c/s/v/d.

Patient is not on any current medications.

Patient has a history of a couple of masses, one behind his left ear and another by his penis. Has a history of an abdominal obstruction.

Currently on Purina One for their main diet. This is a grain inclusive diet

Routine wellness items/If not up to date offer

  Bloodwork completed within in the past year? No
  Fecal completed within the past year? No
  Parasite Prevention current? No
  Any concerns with potty training, litter box usage, other behaviors? No

Renton Clinic/Justin Hanson, DVM/Jenifer Villegas Gonzalez, VA

[Note: Chief passed away 8 days later on 7/25/2025]