C09986019 / invoice 10000

Reason: Recheck EarsAppointment Notes: Special payment terms existHistory: Was here a week ago with a left ear infection Owner has been medicating him at home with a compounded medication and he has been alot better Doesnt seem iritated by his ear and has had some chunks of discharge come out.Otherwise well Examine: BAREars- left ear no obvious redness of canal, still some mild brown cerumen present- cytology clear both ears. Cleaned with otoflush and removed some more discharge Plan: Owner to clean ears every couple of weeks at home to maintain.    Vital Signs    

Reason: Ear infection History:Oscar has had an ongoing ear infections since September. Each time it has not fully resolved Otherwise well at home Has hyperthyroidism which is well controlled on carbimazole 5mg BID- last blood test in sept T4 normal No other medications or diseases No recent vomiting or diarrhoea Eating well Diet: canned food in AM, kibble ad lib, raw meat in PM Is on advantage monthly Examine:BAR, lovely boy BCS 4/9Chest ausc- G2-3/6 heart murmur, no arrythmia Normal BV sounds Abdomen- soft and comfortable nad Ears- cocci ++++ left, right NSF Eyes- nad Ambulating well Assessment:Left ear otitis externa, cocci- heavy amount of discharge and cocci present. Has previously had dermotic and owners have struggled to get the medication in adequately. This may be why there is a non resolving issue. Cleaned the left ear with otoflush and removed a large amount of cerumen. Cant assess TM, discussed risk of rupture since ongoing since September and opted for middle ear safe compounded mix. Treatment:Cleaned left ear with otoflush Compounded tears naturale, enrofloxacin 7.5ml, dexmethasone (5mg/ml) 2.5ml Plan:Revisit in 7 days to reassessNext step would be to consider an ear flush. Also needs a dental so coulf potentially do together but did let the owner know that if dental was going to be long procedure then may need to do separate to ear flush due to age and cardiac risk (murmur).    Vital Signs    Weight: 5.08;