C09987126 / invoice 10000

Reason: C/u + VaccinationAppointment Notes: Overdue reminders  ------- Sms reply: YesPATIENT:ChewieBrown maleWeight:Reason: Recheck ears, vaccination dueHistory:Chewie is a brown male dog presented today for recheck to monitor ear condition. Owner reports still gunk in ears, cleaning every night, decreased each time but still present. One episode of vomiting. No diarrhoea. No head shaking. Not bothered by ears. No scratching except during cleaning. After cleaning, flaps ears and wipes face, then bites feet.Current medications: Antibiotics (finish course), P and P ear medicationExamination:Vitals:    - Temperature: N    - Heart Rate:N    - Respiratory Rate:N    - Weight: NPhysical Exam:Cs Ok legs okabd ok    - EENT: Right ear - significant debris, moist. Left ear - less debris than right, still waxy, moist.Diagnostic Results: Cytology both ears - bacteria significantly reduced compared to previous. Left ear slightly more bacteria than right. Right ear took longer to find bacteria on microscopy. rods found left ear neutrophilsASSESSMENT:Chronic otitis with reduced bacterial load but persistent moisture and debrisCurrent treatment not effective enoughPLAN:vacc C5Diagnostic/Treatment Plan: Clean ears today. Apply clotrimazole gel to dry out ears. Continue P and P but cease cleaning. Finish antibiotics. No bathing at this time. Recheck in one week.Recommendations: If no improvement, may trial compounded gel (enrofloxacin, dexamethasone, mometasone) or consider referral to dermatology specialist.    Vital Signs    

Reason: Phone (voicemail)CT:O wanted to book check up and also Chewies Vaccination for nex weekO also wanted to confirm instructions on Pred Label:1 tablet a day for 3 days, then 1/2 a tablet once a day for 3 days then 1/2 a tablet every second day    Vital Signs    

Reason: Recheck EarsAppointment Notes: ------- Sms reply: YesPATIENT:TimmyWeight: 7.2 kgReason: Recheck bilateral ear infectionHistory:Timmy was presented today for recheck to monitor bilateral ear infection. The owner reports still a lot of discharge in ears, cleaned last night with significant debris removed from one ear. Shaking head, biting at feet and between ears. Skin on neck appears thin and dry since shaving. Eating well, active, loving food. Drinking pattern unchanged - tends to go hours without drinking then drinks large amounts.Current medications: Polymyxin B ear drops, ear cleaner, prednisone (4 days given 10 days ago)Examination:Vitals:    - Weight: 7.2 kgPhysical Exam:    - EENT: Both ears have less wax than previous visit, less nasty/horrible wax. Right ear worse than left. Right ear appears ulcerated.    - Integument: Skin on neck appears thin, dry. Possible reaction to shaving or medication.Diagnostic Results: Ear cytology - Left ear: bacteria 3+ (previously 10+), no neutrophils seen. Right ear: bacteria 5-6+ (previously 6+), high white cell count indicating ulceration. Sensitive to polymyxin B and marbofloxacin. Intermediate sensitivity to enrofloxacin.ASSESSMENT:Bilateral Pseudomonas otitis - left ear significantly improved, right ear still problematic with ulcerationSkin changes on neck - possible reaction to shaving or medicationPLAN:Diagnostic/Treatment Plan:    - Marbofloxacin 35mg PO once daily for 10 days (script provided for Petchemist)    - Prednisone: 1 tablet once daily for 3 days, then half tablet once daily for 3 days, then half tablet every second day    - Continue polymyxin B ear drops 0.5ml each ear twice daily    - Continue ear cleaning - clean, wait 10 minutes, allow shaking, then apply drops    - Oatmeal-based shampoo for skin - leave on for 10 minutesRecommendations:    - Recheck in 2 weeks - at least 1 week on marbofloxacin before reassessment    - If ears not improving, may change antibiotics    - If drops run out, call clinic for refill    Vital Signs