C09982447 / invoice 10000

03/03/2026 Current with Simparica Trio. No iw tabs given. Does not get anything specific for teeth. Is food orientated but not very good at chewing. Coughing mostly after drinking water. O feels less interested in walks and more panting. Has not checked resting RR for some time. Just finished oral ab for ear, NSAIDs a few days ago. O does not feel much improve with ear. Still quite moist and strong smell. No recent scooting. Has a lump on inner R pinna and lump near base of L ear is slowly growing. Neither lump bothering Eevie. 
PE: mm-pink, moist. CRT1s. Mild dental dx, esp canines and carnassial teeth. Right ear canal opening is crusting and moist dc palpable. On swabibng watery dc. Left ear mild ceruminous dc. Not pruritic on swabbing. Eyes, LN, hrt/lng snds, abdo palp, skin, coat normal. HR120, reg. BCS 5.5/9. Gr 4/6 murmur bilaterally. Cutaneous mass 4mm right inner pinna consistent with adenoma. Mass near base of R ear consistent with sebaceous cyst. Expressed with pressure.
Path: R ear bacterial otitis externa. 
Tx: Nobivac Flex DHP + Bb/Pi #2528102. Cleaned right ear. Applied first dose of Topigen. 
Expressed material from sebaceous cyst and cleaned with chlorhexidine. Likely to refill and recur. 
Discussed heart murmur. Recommend echo to assess. O likely to go ahead. Logistically best to do with recheck of right ear so to organise for 10-14d time.
Recommend brushing teeth and more chewing overall.