C09980022 / invoice 10000

R ear flared up early hrs of the morning, sore and inflamed.
Otherwise well in self.  Did have small bilious V+ a few days ago but no others and no D+. Eating/drinking normal.
No current meds

R ear dark discharge, inflamed, not able to clearly see TM due to discharge.
L  ear sl dry yellow wax, no inflam.

In house cytology:
L ear NAD.
R ear neuts ++++ cocci ++

Discuss options, elect EKT today, rpt with nurse 1 week, then re-see with vet 7-10days for cytology.  If ongoing infection then discuss culture vs ear flush (vs both).

Sore again with R ear ~ 1 week, maybe a bit off in self too.
Not able to get in here sooner and had some Dermotic left, so O has used a bit of this, last dose last night.

PEx QAR, good boy, taking treats gently.
Mms pink, moist, crt 1s.  Dental grade 2 upper carnassials, rest of teeth lovely.
Thoracic ausc/abdo palp NAD.

L ear mild inflam, gloopy yellow discharge.
R ear bit more inflamed, brown liquidy discharge.  
Both ears no obv FB and TMs appear intact.

Cytology R ear may be limited with recent Dermotic use.  Could do just L ear.  Other option to Tx presumptively, and then cytology at end of Tx course.  Discuss Dermotic + Otoflush vs EKT.  Elect Dermotic + Otoflush.
Tx 10ds, re-check ~2ds later.

NB O will bring back for rpt bloods for liver enzymes (see Hx) early next year, currently dealing with v expensive horse vet bill.

Painful in one ear, unsure which one. 

Very good boy. Quiet. 
Right ear- full of dark discharge, cannot see TM. Cytology: +++cocci, + malassezia, some degenerate neutrophils
Left ear- small amount of brown discharge. TM ok. Cytology: clear

Right ear otitis externa

Dermotic R ear BID 14 days. O has some at home, but if this bottle runs out ok to pick up more 
R/v 14 days. 
advise using Otoflush once a week