C09979766 / invoice 10000

D/C
L pupil bigger than normal R pupil
Discussed anisocoria which can sometimes happpen for 48-72 hrs post ear flushing.  If perists or any other symptoms noticed call us or RV.
Canal has cawliflower growth making it narrower.

Start Otomax drops from tomorrow am.

Predx 5mg 1/2/3, 1/1/4, 0.5 eod 1w, 1/2 weekly with food until finsihed.

RV 7d and assess if Otomax has to gon for longer.

Admitted: Ear flush
GAP ONLY

GA Surgery/Procedure - ear flush 

Admitting nurse:MJ
Client present: yes
Anaesthetic nurse: MJ
Writing nurse: LF


Pre-ga bloods - declined 
Chest X-Ray -declined 

IV Fluid type: Hartmanns
Rate:  80mL/hr throughout procedure
 
Sedation drugs:
Methadone - 0.2mls IV 
 
Induction drugs: 
alfaxan 2mls iv 

Intubated with #  7mm ET tube

Anaesthetic Circuit used...circle 

Anaesthetic maintenance method: Iso/02 @ 2%/2L

Veterinarian Notes:
R ear - lots of flocculent whitish material flushed out using Otoflush solution, finally canal clean.  Cawliflower at entraance of canal making it restricitive.  P will require Pred at d/c.
R eye - no redness of d/c seen


Noticed L pupil biiger than R pupil being mid sized.  Thonk post effect of flushing whihch I have seen in some dogs.  Generally gets better after 48-72 hrs.

Rechecked after 1 hr - both pupils normal now, P fully awake and sitting up


Ancillary Drugs:
    Pain relief:
    Antibiotic:
    Other: niramine 1.0mls IM 

Medications to take home:
    Pain Relief: 
    Antibiotics:
    Other: Neocort to be applied to pinna 

Otomax 4 drops bid 7d
Pred 5mg 1/2/3, 1/1/4, 0.5/eod 1w, 1/2 weekly wf.

Recheck with: 
r/c 1 week with AP 

Home care notes: 

Eyes / Ears / Skin (Ear infection) -

Very friendly 

HISTORY:
in the last 3 days the right ear and high have become worse. 
not eating in the last 3 days. 
scratching face and licking paws 
O gave NAS probiotic the last few days 
screaming in pain when touching head 

Mother has given Meloxicam and started to Noroclav 250mg 1 bid 2d

Diet:dry kibble and prime 100
Prohylaxis:NS monthly 

VET EXAMINATION:
General Demeanor: BAR
Behaviour: friendly
Oral Exam: MM pink, moist, <2 sec CRT, Dental Grade: 1/4
Ears/Eyes/Nose: RHS head tilt, R ear canal ppzing yellowish crusty and moist d/c, smells mod painfulClear and free of discharge, L ear fine
R eye yellwish d/c, L eye finbe
Cardiovascular: Regular rate and rhythm, no murmur auscultated
Respiratory: Regular respiratory effort, lungs sound clear bilaterally
Skin/Coat: No abnormalities detected
Peripheral Lymph Nodes: Palpate WNL
Abdominal Palpation: Soft and comfortable
Genitourinary: No abnormalities detected
Rectal/Anal Glands: Rectal not performed
Musculoskeletal: No neck or spinal pain detectable. No detectable abnormalities on limb palpation and manipulation.
Neurological: No abnormalities detected
Temperature:    c

LABORATORY/IMAGING: 
Smear R ear - lots of Rods (no malasezzia)


ASSESSMENT:
OE (R)
Conjunctivitiis (R)

TREATMENT:
Tricin R eye bid 7-10d

Continue with Meloxicam for 2d then stop
Since O has started with Noroclav, best is to continue to dry up pus before flushing next Tues.
(Noroclav 250mg 1 bid for another 5 days = total 7 days (if O runs out can have dispensed to treat for upto 7 days from 23/2/26))

PLAN:
Ear needs to be flushed clean before starting on topical