C09988497 / invoice 10000

Reason: Ear / Infection, Left ear, scrating a little started 3 days agoWould like some neocort cream and some more ApoquelHistory: No v/d. Dude as normal. Not pupd. Has been scratching at L ear a bit last couple days and noticed it is quite red. Uses ear cleaner regualrlyNo change with hypoallergenic diet trial Has used neocort cream in the past when hot spots have come up Does occasionally bite at paws but under control with apoquel. Usually flares up in summer monthsUtd with flea prevention and vaccines Last bloods in july showed high ALP and low T4. USG was normal so unliekly cushings Examination: BARMm p +m, crt <2secs. Quite a lot of teeth missing as had prev dentals, remaining have calculus build up LNs wnl L ear red, can see TM. Mild discharge. R ear wnl HR - 92, reg, no murmur. Lung fields clear. Nad on abd palp. BCS 5/9.No ertyhema on paws apart from LH small patch of erythema localised area Laboratory: Adv ear swab from L ear - showed cocci and minimal yeast Assessment: Treatment: Adv AB drops for L ear twice daily for 7 days. Rv ini after this periodCont with apoquel - dose reduction as reduced weight today. Aware extra cost, can give 1/2 tablet 16mg to make things cheaper but upper reference range. O happy to go ahead with 5.4mg today Given necort to use for the LH paw lesion Clean ears before using AB dropsDisc bloods today and if low T4 consider adding on free T4 and TSH +/- dental if bloods okay. O would like to see ear clear up first then will enquire re this Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:Nurse: -vaccination UTD-heartworm NGS UTD-worming -flea/ticks NGS UTDBAREDDuNo V+ or D+ to reportLS--- 04/03/2026 09:22:11 AM LFD:Examinations - Resolved -    Vital Signs    Weight: 13.3;