C09987695 / invoice 10000

Jed has been previously diagnosed with discoid lupus and pruritic skin disease.Currently being managed with apoquel.O has moved into a new house last April and backyard has a sand pit in it.Jed was digging around in the backyard last year and had some sand in his L ear, developed into an ear infection. He required an ear flush at that point and ear infection cleared.Recently got sand in his ears again and has been scratching at L ear again.Was started on a 2 week course of steroids and developed multiple side effects - PU/PD, excessive panting, changes in behaviour, weight gain.O reports ear scratching is not getting any better.Jed has yet to have a full allergy work up - O has not had a discussion on diet trials etc.Examine:L ear mod ceruminous discharge, mild erythema and swelling. Unable to visualise TM due to discharge blocking visualisation. R ear mild erythema and swelling. Erythema on muzzle just caudal to nose. Cytology L ear: cocci ++, R ear: no infectious organisms.Assessment:L bacterial OE likely secondary to sand and pruritic skin disease.Discussed causes of pruritic skin disease with O - food allergy, environmental atopic dermatitis, flea allergy dermatitis, others.Discussed elimination food trial with O - recommend hypoallergenic or novel protein diet for at least 2 months.Recommend continuing with apoquel during that time. After two times, to trial coming off apoquel for a few days to assess response to food trial.If pruritus improves, likely some degree of food allergies in play. To discuss food challenge at that point.L ear flushed with otoflush.Treatment:Osurnia in L ear.Plan:Recheck L ear in 1 week, repeat cytology to determine if another dose of Osurnia required.O interested in attempting elimination food diet, recommend starting on R/C hypoallergenic, O will attempt to source online.03/03/2026 2:22:30 PM CA:Jed is still not fully comfortable, but is shaking his head less. Is also whimpering less too, so O believes is doing a bit better. Recheck scheduled for Saturday, confirmed with O- CA    Vital Signs    Weight: 38.2;       MMColour: Pink;       HeartRate: 132;       HeadEyes: Normal;       Nose: Normal;       Skin: Abnormal (Erythema on muzzle just caudal to nose. );       MusculoSkeletal: Normal;       Ears: Abnormal (L ear mod ceruminous discharge, mild erythema and swelling. Unable to visualise TM due to discharge blocking visualisation. R ear mild erythema and swelling. );       Neck: Normal;       LymphNodes: Normal;       Heart: Normal;       Lungs: Normal;       Abdomen: Normal;       RectalGenetalia: Normal;       Demeanour: BAR;       Hydration: Normal;       Gingivitis: 0;       Calculus: 1;       Observation: Normal;       BodyScore: 6;       DentalGrade: 1;       CRT: 1-2;