C09990595 / invoice 10000

Appointment Notes: ears. SCHistory: ears about a week Keep shaking his head EDDU NAD no V+/D+ Diet: Kibbles mainly HISTORY:CURRENT DIET:PREEXISTING CONDITIONS: CURRENT MEDICATION: PE:T-HR/CARDIAC-RR/RESP-MM-CRT-LNN-ABD-BCS-OTOSCOPY/EARS: ORAL HEALTH: EYES: MSK: INTEGUMENT: UROGENITAL: CNS: Not routinely examinedPROBLEM LIST:DX:DDX:RX:PLAN:?????HISTORY: Presented for recurrent bilateral otitis externa (head shaking) for one week and hindlimb tremors/weakness for several weeks. History of chronic ear infections and a previous cruciate ligament surgery. Appetite and thirst are normal; no vomiting or diarrhoea. Owner queried if chicken in diet could be related to pruritus.CURRENT MEDICATIONS:PREEXISTING CONDITIONS: Chronic otitis externa. Previous cranial cruciate ligament surgery. Static mass on left pinna.CURRENT DIET: Commercial biscuits. Also consumes significant amounts of chicken.PE:- T-N- HR- RR/lungs:- MM-- LNN-- ABD-- BCS 20.3 kg. Over-conditioned; target weight 18-19 kg.- Otoscopy/ears: Bilateral otitis externa with copious wet exudate.- Oral health:- Eyes:- Msk system: Hindlimb muscle atrophy with compensatory forelimb hypertrophy. Reluctance on hindlimb range of motion. Crepitus palpable in right stifle. Sits with weight biased to the right. Hindlimb tremors noted when standing.- Integument: Mass on left pinna, unchanged.- Urogenital: Not routinely examined.- CNS: Not routinely examined.Lab:PROBLEM LIST:1. Severe bilateral Malassezia otitis externa.2. Suspected osteoarthritis secondary to previous cruciate disease.3. Hindlimb muscle atrophy and weakness.4. Overweight.Dx: Severe bilateral Malassezia otitis externa. Suspected osteoarthritis of hindlimbs.DDx: For hindlimb weakness: Hip dysplasia.Assessment: Severe yeast otitis requires aggressive topical therapy. Chronic nature likely multifactorial (breed conformation, moisture). Hindlimb weakness and tremors attributed to disuse atrophy and chronic osteoarthritis. Weight reduction is critical for managing musculoskeletal issues.Rx:- Topical ear medication BID.- Oral steroids, starting tonight.- Oral joint supplement daily.- In-clinic ear clean performed.PLAN:- Recheck in 1-2 weeks for ear examination and cytology.- Commence weight loss plan and exercise modification (short, 5-10 minute walks BID).- Owner to begin daily joint supplement.- Owner educated on routine ear cleaning (fortnightly and after bathing).- Discussed further diagnostics if required: hip/stifle radiographs, ear flush under general anaesthetic.- Pain relief may be required if current plan is insufficient for mobility.?????    Vital Signs    Weight: 20.3;