C09977345 / invoice 10000

Appointment Reason: Ear problem, Appointment Notes: AIHistory:ear infx noted when came back from kennels about a week agothere was a lot of discharge in his R earbeen cleaning with Epiotic twice daily, then 5 mins later apply PMP; been treating both earsHad a severe ear infx flushed bilaterally under GA about 3 yrs agoDUDE no concerns; energy levels normlLaboratory: Otic cytology - R ear - 3+  malassezia, 1+ neutrophilsL ear - NADAssessment: R ear malassezia OETreatment: - Clean with Epiotic SID - wait at least one hour before applying PMP- PMP 1ml BID x 10 days in R earPlan:-Revisit in 14 days- Once both ears are infection free, consider using ongoing maintenance flushing - Epiotic every 7-14 days; then 24 hours later use Kleo ear cleaner as ear drops (to help reduce pH and prevent yeast overgrowth)- Alternative to Kleo, if need anti-inflammatory consider using Elocon lotion.    Vital Signs    MMColour: Pink;       HeadEyes: Normal;       Nose: Normal;       Skin: Normal;       MusculoSkeletal: Normal;       Ears: Abnormal (R ear canal very inflamed and brown crumb-like discharge +++  unable to see TM ; L ear canal free of inflammation and discharge TM intact);       Neck: Normal;       LymphNodes: Normal;       Heart: Normal;       Lungs: Normal;       Abdomen: Normal;       RectalGenetalia: Normal;       Demeanour: BAR;       Hydration: Normal;       RespirationRate: 32;       HeartRate: 108;       BodyScore: 5;       CRT: 1-2;