C09988530 / invoice 10000

05/03/2026 Ears has been an issue for a bit but worse last Thursday 

has been cleaning them at home - noticed more waxy discharge 
has been head shaking 
maybe some dry blood from his ear 

Eddu normally 

did have some conjunctivitis in left eye and stopped after 5 days 
now noticed that both eyes are a bit gunky 

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yellow discharge in the medial canthus of both eye 
still suspicious of allergic conjunctivitis 
very minimal irritation to eye 
slightly increased vessels to conjunctiva of both eyes 


Teeth DD 0 - good dentition 

ears 
Left ear - redness to pinna with brown waxy discharge - worse then right 
Right ear - mod waxy discharge 

Otoscopic exam 
L - large amount of waxy debris, very irritated, TM not visible 
R- - some waxy debris, Slightly irritated - TM visible and normal 


Popliteal and sub man Ln normal 
comfortable on abdominal palpation 

HR - 92 no murmur or arrythmias 
RR - panting 

LABORATORY
Ear smear 
L - malassezia 20 per HPF and cocci  20-30 per HPF
R  - Malassezia 1 per HPF 

TREATMENT:
Bova Dexamethasone Enrofloxacin Ketoconazole in Poloxamer 0.1% 1.5% 2% Otic Gel
1ml into BOTH ears today 

discussed using Elecon lotion once ears are resolved to help with recurrent ear infections 

Revisit in 1 week for reapplication of ear ointment with Nurse 


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NURSE: AC

REASON: Ear concerns - L ear worse than R, dry blood-like discharge after cleaning last Thursday

HISTORY:
- Ears dodgy for a while, particularly bad last Thursday
- Owner cleaned ears, L ear particularly bad
- Dry blood-like discharge noted after cleaning
- Concerned re: possible rupture or grass seed
- Previous ear infection - weekly clinic visits for treatment as owner has trouble remembering at home

APPETITE: Eating and drinking well

**CLINICIAL EXAM:**
- Mentation: Not assessed
- MM: Not assessed
- CRT: Not assessed
- Oral and Dental Score: Not assessed
- Eyes: Conjunctival vessels enlarged, sclera affected, likely allergic conjunctivitis
- Ears: L ear significantly worse than R, infection present
- BCS: Not assessed
- Lumps: Not assessed
- Abdominal: Not assessed
- Lymph nodes: Not assessed
- HR: Not assessed
- RR: Not assessed
- Temp: Not assessed
- Urogenital: Not assessed
- MSK: Not assessed
- Skin: NAD currently

**ASSESSMENT:**
- Ear cytology: Yeast + bacteria L ear, yeast only R ear
- Bilateral otitis - L > R
- Likely allergic conjunctivitis

DISCUSSION:
- Discussed ear infection findings
- Allergic conjunctivitis common this time of year, especially in allergic dogs
- Eyes self-resolve but drops available if bothering
- Fluorescein staining contraindicated before steroid use - precaution if ulcer present
- Owner to hold off on eye drops for now, revisit at next appointment
- Discussed Elocon lotion for future management if recurrent ear infections - steroid in lotion form, safe systemically, acts locally, once weekly/fortnightly
- Vicious cycle of ear inflammation explained - harbours yeast/bacteria, creates moist painful environment

TREATMENT:
- Long-acting ear medication administered in clinic

PLAN:
- Nurse appt next Thursday 10:45am for ear treatment
- Recheck 1/52 after for infection management
- If controlled, may start Elocon for ongoing management
- Fluorescein stain at next visit if eyes still bothering
- Further discussion re: eye drops at revisit