C09983253 / invoice 10000

NURSE: MS

REASON: Reason for presentation: Recheck of ear infection + Cytopoint.

HISTORY:
- Chronic history of ear infections.
- Had an ear flush under GA approx. 1 year ago (17/03/2025).
- Previously treated with Dermotic, Surolan, Osurnia, and a steroid once a week. Switched from Osurnia to compounded gel approx. 3 months ago.
- On a strict diet.
- O's temporarily living in Sorell waiting on birth of baby.

APPETITE: Eating well.

ACTIVITY: Not assessed.

DIET: On a diet. Kangaroo treats are okay.

TOILETING: Not assessed.

CURRENT MEDICATIONS: Cytopoint injection for allergies. Previous dose 07/02/2026.

CLINICIAL EXAM:
- Mentation: BAR
- MM: Not assessed
- CRT: Not assessed
- Oral and Dental Score: Not assessed. Had a dental recently.
- Eyes: Not assessed
- Ears: Cytology shows yeast in both ears. Significant waxy debris present bilaterally. Bad conformational change, very stenotic canals.
- BCS: Not assessed
- Lumps: Not assessed
- Abdominal: Not assessed
- Lymph nodes: Not assessed
- HR: Heart sounds nice and regular.
- RR: Chest sounds clear.
- Temp: Not assessed
- Urogenital: Not assessed
- MSK: Not assessed
- Skin: Skin looks quite good. Itchy under her armpits.

ASSESSMENT:
- Cytology revealed yeast in both ears.
- Chronic otitis externa secondary to allergies and conformational changes.
- Cytopoint is helping with general pruritus but not fully resolving ear issues.

DISCUSSION:
- Discussed with owner that the conformational changes in the ears mean chronic ongoing issues are likely.
- Discussed that waxy debris can prevent medication from penetrating effectively.
- Discussed option of another ear flush under GA as it has been over 6 months since the last one.
- Advised owner that maintenance therapy (e.g., weekly steroid drop) will likely be required long-term.
- Discussed risks vs benefits of ear flushing.
- Discussed treatment plan for this current infection.

TREATMENT:
- Ears cleaned in consult.
- Compounded long-acting gel (2ml) instilled into both ears.
- Cytopoint injection administered (2 x 30mg injections, as it is cheaper than 1 x 40mg + 1 x 20mg).

PLAN:
- No cleaning of ears at home.
- Return in 1 week for nurse appointment for second dose of in-clinic ear medication.
- Return in a further week for a vet recheck and repeat cytology.
- Owner to consider another GA ear flush if current treatment is unsuccessful.