C09977921 / invoice 10000

Appointment Notes: Recheck ears. NR  ------- Sms reply: Yes?????History:Mo presented for a recheck of an ear infection. The owner reports the ear remains mildly pruritic and has developed a malodour and brown discharge over the last 48 hours, worsening after recent rain. The owner has been applying topical ear medication but reports difficulty with deep administration. A previous ventral skin lesion is now resolved. The owner notes occasional vomiting of yellow bile and intermittent inappetence, and questioned a potential link between gut health and the ear condition.- Significant history: Previous diagnosis of yeast otitis externa.- Current medications: Unspecified topical ear medication - twice daily.- Appetite & diet: Fed Blackhawk kibble and home-cooked food (chicken, rice, peas). Appetite is intermittently reduced.Examination:Vital Signs: BAR, HR WNL, RR WNL, Temp WNL, MM pink, CRT <2sec, Skin tent WNL- Eyes: No blepharospasm, no conjunctival hyperemia, no epiphora.- Ears: Affected ear is warm to the touch with a malodorous, brown exudate. Cytology confirmed significant yeast overgrowth.- Oral: Grade 0 dental disease.- Nose: NAD.- Cardiovascular: No murmers or arrythmias.- Respiratory: Clear broncivesicular sounds on all lung fields.- Skin: Previous lesion on ventrum is resolved. Normal coat, no ectoparasites.- Abdomen: Soft, no masses palpated.- MSK: Ambulating normally. WBx4, good ROM all joints. No spinal pain.- Lymph nodes: Submandibular, pre-scapular and popliteal LNs WNL.- Urinary/Genital/Rectal: Not assessedAssessment:Problem List:* Recurrent/persistent Malassezia otitis externa.* Intermittent vomiting and inappetence.Treatment:In-clinic ear flush and application of long-acting aural medication.Plan:* Recommend transitioning diet to Hills Gastrointestinal Biome kibble.* Recheck consultation in two weeks to assess response to treatment.Client Communications:Discussed ear swab results, confirming a persistent yeast infection with no secondary bacterial component. Advised the condition is likely environmental or breed-related. Explained that a second course of treatment is sometimes required. Recommended a diet change to support gut health.?????    Vital Signs    Weight: 13.2;