C09983340 / invoice 10000

04/03/2026 In With: Carla 

Reason:  ear recheck, a bit late for it. 

Hx: is still scratching ears . last dose of pmp last night

E:
BCS: 3/5
MM  
Dg  0/4 on most teeth
HR-  120
Eyes - NSF
Ears - R ear Nsf but can't see past hair - cytol - nsf, L ear - liquid and hair -cytol - lots of yeast and some cocci 
Chest -NSF
Abdo - NSF 
Skin/coat - nsf
MSK - no obvious mm atrophy, ok rom in joints
T - not taken td 

A:  otitis not resolved, likely dt ear hair not helping and/or allergic skin dz 



P: recommend ear flush under short GA to flush and clean L ear, poss pluck R ear at the same time. O declines td but will trial
cytopoint (40mg) s/c given , and continue dermotic
if runs out of drops, ok to dispense anothe rbottle within the next 2 wks as need to do for 10 days and recheck in 14 days , sooner if probs

O will consider asking groomer to pluck hair from ears

once otitis controlled, may want to consider hypoallergenic diet or eliminationdiet  trial to see if otitis is food responsive as young dog