C09978871 / invoice 10000

Dear Catherine, Kevin presented today with sore ears and a rash on his abdomen. Samples were taken from his ears and skin. There was yeast (fungus) in both ears. He has an ear infection in both ears, but the left is worse. Chronic intermittent ear infections are most likely secondary to allergies. The sample from his skin showed white blood cells indicating active infection. He was on antibiotics for his skin 2 weeks ago. Either he was not treated long enough, there is a resistant infection or it is a new infection. These skin infections occur secondary to due allergies. Allergies can be due to a food allergy eg a meat, but most likely Kevin has Atopic dermatitis (allergy to something in the environment). Today we cleaned his ears with an ear cleaner. Plan: otomax 0.5mls in both ears morning and night for 10 days left ear, 5 days right ear. Once the infection is clear he would be a candidate for ongoing steroid ear drop maintenance at home. Cephalexin 200mg (antibiotics)- Give 2 tablets orally morning and night for his skin. Recommend making a revisit appointment in 2 weeks to recheck his skin and ears.Malaseb - bathe his entire body (focusing especially on the itchy spot) once weekly, but if you can twice weekly until skin is clear. Leave on for 10 minutes before washing off. Ensure he is up to date with nexgard spectra mthly. Atopic dermatitis needs to be managed. Itchy skin flares can be managed with allergy medications/ injections as needed and secondary infections treated. Each patient needs a tailored management plan. Specialist dermatologist referral for allergy testing can also be arranged. Do not hesitate to contact us to discuss further. Thanks, kind regard, Dr. Lauren Drummer    Vital Signs    

Reason: Skin & Ear Problems Appointment Notes: Overdue remindersHx: Diarrhoea resolved - most likelky related to scavenging bahmi. Generally poos good normal diet. Diet: kibble, chicken/ rice/ sometimes raw hide-  farmers market. Yesterday changed to NOOD. Utd ngs Previous hx: Diarrhoea 6 weeks ago. Previous otitisPapules on belly. Hx of atopy. Responds well to steroids. Diet: chicken and rice + veggies + kibble. No changeUTD nexgard spectra Medications: Cephalexin 2 weeks finished 1 mth agoCytopoint 6 weeks ago.Vbad ear 07.25 otomax and ear fluash under GAPE: do not touch feet growl or tail. HR 160. Rr pantingMod tartarNS oULet worse >right ear Integ: 21cm lump left chest soft 2cm left shoulder soft SQ 1.5cm lump near tip tail. Collaretes inguina/ few dorsum and tail.  Does not like blkadder papation Plan: already discussed dental.No to cytopointRecheck 2 weeks May need etxened abs or culture swab    Vital Signs    Weight: 16.8;       

Reason: Diarrhoea Last Few Days, Blood In Poo, Licking Appointment Notes:  a lot MDHistory:D+ for a few days, blood in it todayOff his food. Lethargic. V+ yesterday Drinking okIs a scavengerLicking at skin. Papules on belly. Hx of atopy. Responds well to steroids. Diet: chicken and rice + veggies + kibble. No changeUTD nexgard spectra Medications: none Physical exam:BAR. Very bright in consult. Barking. MM pink moist, CRT 1-2s Grade 3 POD. Marked calculus and gingivitis. Cardio/resp fine. Panting. HR = 112 Mild pain on abdo palpation Papules on belly  Temp: 39.5Assessment:Gastroenteritis. Ddx: gastro vs extra-gastro. Prev pancreatitis. Bacterial pyoderma ventral belly and surrounds Underlying atopy. Treatment:Cephalexin 23mg/kg PO BID Pro-kolin 3ml BID Cerenia 1mg/kg sc Cytopoint 20mg Plan:Strict rest. INI then return for repeat bloods + abdo scan Requires ongoing atopy care. Rec ongoing cytopoint monthly Weight loss. Ideally <14kg Dental with likely extractions    Vital Signs    Weight: 16.8;