C09982800 / invoice 10000

Appointment Reason: 1.2 CONSULT 2, Appointment Notes: . Sent sms/unable to leave vm - KAGPaws App Details:Booking Type: Consultation (Up to 2 concerns)Booking Notes: Potential ear infection. Owner Are you a Pet Club Member?: NoOwner Are you interested in learning more about our Pet Club?: NoPet Insured: YesSubjectivePresenting Concerns:  Ollie presented for assessment of his AS. The owner reported it appeared gunky, red, and larger than the AD. A history of paw licking was also reported.    Historical Conditions:-   History of allergic dermatitis, diagnosed by a dermatologist.-   Previous ear cytology performed in 2024.  Skin & Coat:-   Intermittent paw licking and biting, sometimes causing redness between the toes.-   Diagnosed with male pattern baldness by a dermatologist.-   Owner recently noticed a new, tiny skin tag on the lip.  Current Medications:-   Apoquel 5.4 mg: Administered as needed for pruritus. The owner has given it for the past few days.ObjectiveMentation: BAR  Wt: —  BCS: --/9  T: Not taken  P: —  R: —  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: Anxious during the consultation, particularly with ear handling. Accepted a treat.    Eyes: Clear. No discharge or erythema OU.  Ears: A large amount of thick, brown, waxy discharge was swabbed from the AS canal. A smaller amount of similar discharge was present in the AD.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: A tiny skin tag is present on the lip.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin. A tiny dermal skin tag is present on the lip.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   Ear Cytology (Bilateral): Increased numbers of cocci bacteria were found in AU. Minimal yeast was present. The sample from the AS contained more debris. The owner approved the cost of $65.AssessmentBilateral Bacterial Otitis Externa - The infection is more significant in the AS. This is considered a flare-up likely secondary to underlying allergic skin disease.    Allergic Dermatitis - Suspected, based on the history of paw licking, response to Apoquel, and recurrent ear infections.    Dermal Mass, Lip - A tiny skin tag is present. Given the patient's anxiety, sampling was deferred. Recommend monitoring for changes.PlanMedications/Treatments:-   PMP Otic Ointment: Apply 0.5 mL into each ear BID for 7 days. The cost is $66.87. The first dose was administered in the clinic, and the owner was shown the correct technique.-   Apoquel 5.4 mg: Restart daily dosing to manage the allergy flare-up. Give 1 tablet BID for 3 days, then decrease to 1 tablet SID for 7 days. After that, the dose can be tapered further to the lowest effective dose (e.g., half a tablet daily or q other day).  Additional Discussion:-   A recheck examination is recommended in 10 days to assess the response to treatment.-   Advised to avoid bathing until the course of ear medication is complete. On the last day, the owner can bathe Ollie but should place cotton balls in his ears to prevent water entry.-   The owner was advised to monitor the skin tag on the lip and that it could be removed and submitted for histopathology during a future procedure, such as a dental cleaning.-   The owner consented to the diagnostic and treatment plan.    Vital Signs    Weight: 11.4;