C09984869 / invoice 10000

Reason: Ear flushPre-op examination: Sedation: 0.03ml medetomidine & 0.05ml Butorphanol IMAlfaxan given to effect to enable examinationPulse ox, NIBP monitored throughout procedure.Ears examined with otoscope: Findings include:Both ears have discharge and inflammation. Bleeding with examination of both ear canals at the proximal ear canal opening.Discharge present in both ears.TM intact in both earsExtremely stenotic ear canal R earEar canal L ear normal size but inflamed.Ear smear cytology findings:Predominantly inflammatory cells seen- lots of degenerate neutrophils, squamous cells and debris, occasional yeast, moderate cocci presence. Excess hair and discharge removed from ear canals Ear canals flushed with NaCl until cleanAnal glands full and expressedNails trimmedTeeth brushed with gauze. Looking goodAssessment: Very strong inflammatory response in the proximal ear canals of both ears.  Bleed easilySevere stenosis of R ear canal - TECA may be needed. Overall greater inflammatory response on cytology compared with microorganism presence.Medications:0.5ml mometamax instilled via catheter into both ear canals.Given there is an obvious issue with the proximal canal opening, I think there is a primary atopic issue here and we will also need systemic medications cephalexin and prednisolone. Plan:Home with systemic meds to start today - check when last metacam was used. Cannot use them both together. Metacam last night. Start pred tomorrow morning RV Tues to recheckRepeat cytology prior to cessation of treatment. Ongoing management with ear cleaning at home.     Vital Signs    Weight: 2.6;