C09990887 / invoice 10000

Reason: Recurring Ear InfectionHistory:Went well with dermatologyGets very stressed with ear medications and rarely successful - maintenance has been hardKept out of water and irritated by pawsSuspect ear infection started about a week ago, not settling and has trouble finding time to get in hereDiet: RC dryExamination:BARMm pink, crt<2sVitals all goodEars - left ear is clean aside from mild yellow cerumen, open and no inflammation evident. Tympanum not obstructed from view and appears to be intact and healthy.Right ear mildly inflamed externally and down canal, tympanum obstructed by small amount of thick dark brown cerumen.Cytology - nsf left year, none of the typical malassezia seen, poss some other round forms of yeast? But <1/hpfRight ear - loads of cellular debri, minimal neutrophilic inflammation evident, no bacteria seen, malassezia >15-20/hpf.Assessment: Otitis externa right earTreatment: Given difficulty with medication, suggest osurnia, Marissa was happy to have this instilled today. - ear clean witrh epi-otic bilaterally- Osurnia instilled in right ear onlyPlan:Due for revisit with dermatology next weekDiscussed Anallergenic diet as a consideration as well as allergy testing given how difficult Millie is to medicate with cortavance weeklyRecheck as needed.    Vital Signs    Weight: 28.4;