C09981709 / invoice 10000

03/03/2026 Reason:
- Left ear suspected infection, vulva concerns, scooting

History:
- Using Epiotic regularly on Fridays for ear maintenance
- No ear infection since August
- Left ear occasionally smells, Epiotic used when noticed
- Scooting - now constant, especially on walks at the park
- Vulva - oozing/discharge noted by wife yesterday?
- Previous visit November for scooting and vulva issues - given wipes
- Previous visit August for ears and anal glands - started Epiotic

Examination:
Mentation: BAR
BCS (0-5):3/5
mm: pmg               CRT: <2s
HR: 110                 RR: normal
Ln:nad
Heart/lungs: NAD. Abdomen: NAD.
Ears: Minimal discharge. No erythema in ear canals. Cytology: Malassezia 1 single one seen in L ear. Nill R ear. 
- Right ear pinna: scratch cranial to ear canal on head. 
Perivulvar area: mild redness, skin mild lichenification. Cytology: NAD
- Anal glands: very full- expressed

Assessment:
1. Anal glands full
- Anal glands very full, likely cause of scooting
- Expressed today

2. Vulvar irritation
- Mild redness and skin roughness
- No yeast or bacteria on cytology
- Monitor post anal gland expression
- If scooting continues, cortisone cream to be dispensed for once daily application around vulva

3. Ear health - stable
- Epiotic working well
- One yeast cell on left ear - not clinically significant
- Continue Epiotic weekly

4. Allergies
- Related to skin, ears, vulva, anal glands
- Currently well controlled
- Fish oils discussed as supplement option - 6000mg daily (3 x 2000mg capsules) - odourless recommended
- Glandex discussed as supplement option for anal gland support
- Antihistamines not indicated at this stage

Treatment:
- Anal gland expression performed

Plan:
- Monitor for scooting - should stop within 24 hours
- If scooting continues, call for cortisone cream prescription
- Continue Epiotic weekly
- Anal glands likely need monthly expression
- Fish oils optional
- Glandex optional
- Anal gland removal surgery discussed - not recommended at this stage