C09985922 / invoice 10000

Client very distressed with news -  just wanted to get home  - lr okayd put GAP thru tomorrow with SX $Any concerns the owner has / presenting problem and duration:Left ear discharge noticed for approximately one week, significantly worsened over the past few days. Black discharge visible on outer ear with malodour. Eyes weeping with discharge noted this morning. History: Recurrent ear infections throughout life, likely contributing to complete deafness?. Previous scabs on left ear last year. Longest period without ear infection currently. Hindlimb weakness noted secondary to age.Previously presented for similar issue: YesDiet:Parasite control:Vacc history:Current medications: ApoquelVomiting / diarrhoea: NoDefecation:NADUrination:NADEating/drinking: NormalExam:Mentation BAR Eyes - clear, cornea all appears WNL, no tear staining Ears - Left ear: black discharge on outer pinna, malodour present, unable to examine further due to patient distressEyes - ocular discharge present, Not able to examine during consult Nose - clear, no discharge Oral - DS mm pink and moist CRT<2s Thyroid palpation - all palpates normal Lymph nodes - all WNL Cardiac: no murmurRespiratory: BV clear bilateral  Abdo - soft and pliable Genitourinary clear MSK - not check due to demeanour Neuro - clear Integument - no masses palpable Temp NTBCS 3/5Assessment:1. Left ear - Very smelly left ear and out ear pinna caudal end look crusty and thick with matted hair on top, try to clip the area with muzzle on and matted hair sloughing off with skin and looks like non viable skin at the caudal end of the left ear pinna, left ear canal filled with blackish gunk2. Right ear - also filled with blackish gunkEar cytology - Bilateral cocci +++++ ,  yeast ++Plan:1. Clip and clean without sedation /GA if difficult and advised to come tomorrow for ear flush under sedation and clip and clean the hair mats , O was advised that we ,may need to crop the ear s well depend on the viability of the skin of the caudal left ear pinna.2. Bup pen dispensed to relieve the pain 3. Need to recheck ears and matted hair in the  left  ear and ear flush and long-term ear meds+/_ ear cropping Estimate given as 900-2000 +195 PAB    Vital Signs