C09971032 / invoice 10000

SubjectivePresenting Concerns:  Heath presented for a recheck examination of her ears. The owner reports that the AS flared up after they stopped administering medication. The owner has since restarted the medication and the ear is improving, but they wanted it checked. A new concern is a lesion on the nose that appeared approximately 2 weeks ago and seems to be getting larger.    History Updates:-   The owner has been applying ear medication (HCA with austrazole)a couple of times per week.-   The owner is running low on the topical ear medication.-   The patient was previously prescribed cyclosporine capsules, and the owner is unsure if they have any remaining at home.ObjectiveMentation: BAR  Wt: —  BCS: --/9  T: Not taken  P: —  R: —  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: —    Physical exam limited to the following areas today:  Ears: The AD appears normal. The AS canal is inflamed and contains purulent discharge.  Integumentary: A lesion consistent with a superficial bacterial infection is present on the nose.AssessmentOtitis Externa, AS - Recurrent infection and inflammation, likely secondary to an underlying condition.    Superficial Nasal Pyoderma - A focal bacterial infection is present on the nose. Skin cancer is considered highly unlikely.PlanMedications/Treatments:-   A Rx for cyclosporine 100 mg capsules will be provided. The owner will check their supply at home before filling. The plan is to restart this medication at a dose of 1 capsule by mouth SID.-   Ear medication: Apply to the AS daily and the AD twice weekly.-   A Rx for Bactroban ointment will be provided. This is to be applied to the lesion on the nose. It was discussed that this is not harmful if ingested.  Additional Discussion:-   A recheck examination is recommended in 1-2 weeks to monitor progress.    Vital Signs