C09979027 / invoice 10000

REASON - VaccinationHISTORY - Rosie has been well. O uses otoflush to clean her ears twice weekly - they are always dirty, right side is always worse. She loves food, and often steals other dogs food. Vaccination overdue by 5 months. O brushes her teeth SID to BID. EXAMINATIONBAR, heart and lungs sound normal, grade 1 dental disease, both ears have brown discharge - worse in right side, unable to see TM either side. Cytology - malassezia up to 20/hpf right side and 10 left side. ASSESSMENTBilateral otitis externaDental diseaseTREATMENTPred 5mg - 1 and 1/2 BID for 5 days, then SID for 5 days, then eod for 3 txs with food. Dermotic BID for 14 daysPLANRecheck 14 days. O about to go away for 3 weeks, but son will bring her for recheck. Discussed that GA for ear flush and dental likely be next step, O says ok if needed, but will wait until she is back. Discussed pred usage and potential for side effects. Vacc when better. Discussed possible underlying allergies as cause of ear infections.     Vital Signs    Weight: 15.5;       

Otoflush    Vital Signs    

REASON - Recheck ears, vaccinationHISTORY - Rosie has been well. Ear medication was tricky first few days, but then she settled and it became easier. No outward side effects from pred.  Monthly combination parasite control used and 3 monthly tapeworming.EXAMINATIONEar examination - both ears appear clear. Cytology on L still has malassezia up to 5/hpf. Right side clear. ASSESSMENTL mild ongoing otititsTREATMENTC4 vaccine sc (5260008, exp 03/26)BB vaccine po (5245041B, exp 04/26)continue with dermotic BID L ear until bottle runs outPLANC3 due 3 years, KC due 12 months. Recheck ears if any symptoms. Recommend otoflush ear cleaner every 1-2 weeks. Discussed weightloss again.     Vital Signs    Weight: 13.7;