C09978434 / invoice 10000

Reason: Check EarsAppointment Notes: Special payment terms exist, Overdue remindersVeterinarian Name:Reason: O has noticed she is head shaking and the left ear looks a bit more redHead shakingSometimes when o rubs the left ear she yelps. Does not generally have allergiesHas gained weihgt, o has noticed when she is heacier she breathes heavier, snorting inwards more, less when she is lighterGoing to be desexed in july - was told to loose weiht firstExamination:COAT/SKIN: healthyEYES/EARS: eyes nadEars - left ear imldly inflamedUable to perform otoscopic exam on ears as was quite fearful and soreManaged cytology - sore on taking swab sample in both ears - brown wax present in both ears+Bilateral malasezzia infection. Bilateral neutrophils+++ Fairly narrow ear canalsMOUTH/TEETH: -not examined, very fearfulHEART: HR 112, no murmur or arrhythmiaLUNGS: clear lung ausc, no abnormalities in resp effect, ABDOMEN/DIGESTIVE/URINARY: nadCNS/MUSCULOSKELETAL: normal gait in consultl, full exam not performedPERIPHERAL LYMPH NODES: not enlargedWEIGHT/DIET: Body Condition Score: 7/9Assessment:Bilateral otitis externa. Malasezzia and neutrophils++Discussed risks of meds due to not know if TMs are in tact. Discussed GA flush and clean vs trial medsEst made for ear flush, o elected to try meds first, ok'd risksStart otoflush cleaner daily for four days then every few days until revisitDermotic bid for ten days in each earStart pred to reduce inflam. Advised of side effects, not to feed more. Revisit in 2 weeks to recheck ears, continue course as needed vs plan for ear flush and clean if indicatedRecc weight loss prior to desexing as was discussed prevsiouly and advised why desexing is safer when not overweight    Vital Signs