C09991161 / invoice 10000

Reason: discomfort to both ears, pruritic 
History: 
- nil change to recent management except O fed chicken for the first time few days ago 
- O noticed head shaking and head tilt last weekend , thought to be both ears 
- nil change to diet 
- nil other purutic area

Current medications: nil 


What Preventative health cover is being used and do you need to purchase any today?
Vaccination (yearly): x UTD
Worming: x UTD
Flea control (bravecto inj available for dogs): x UTD
Heartworm Prevention (Proheart inj available for dogs): x UTD

Examine: 
Mentation: BAR, friendly 
Body condition score: 5/5
MM: pink,moist                 
CRT: <2s
HR: 78               
RR: 40
LN: WNL 
Temperature: not taken to avoid making dogs nervous 

FACE: Erythema around on both eyes and nose. O reported has been red around those area since she had the dog. 
Oral/Dental stage (>Grade requires scale and polish): nad 
Ears: Yeast smell, tympanic membrane not visualised due to dog temperament, ear canal very inflammed. Cytology: 
Cardiovascular: nad, nil murmur/arrthymias 
Respiratory: thoracic ascultation wnl 
Gastrointestinal: nad, s & c
Integumentary & lumps (measurement, location): nil noticed 
Musculoskeletal: nad, full examination not performed
Urogenital:  nad, full examination not performed
Neurological:  nad, full examination not performed

Problem List:
- OE in both ears 
- tympanic membrane not visualise, so OM not excluded 

Plan: 
- Otoflush, demotic BID for 10 days 
- Pred 0.5tab BID for 5 days, then SID for 5 days then SID for EOD. 10 tablets in total dispensed. 


Follow-up: 
- in 10 day time after ear medication course 
- to discuss underlying allergies and weight control during recheck in 10 days time. 

reason: s/o with vet

O reports doing well at home, a bit irritated with sutures but not licking. 
on exam area of concern from photos yesterday has a mature scab, no exposure wound or granulation tissue
rest of sx sited healed well and sutures loose so all 4 sutures removed

plan: use sock/ecollar for another week until scab falls off. RV if any concerns 

SV reviewed photos sx site, will be 14d post op tomorrow. 
proximal sites appear to have healed, some gaping distal aspect of surgery site. 
all sutures are intact however distal 2x sutures do not appear offering much apposition, 
recommend removing sutures tomorrow (supramid) and letting distal aspect heal via 2nd intension 

STOOP with info, was booked in for s/o with nurse but recommend booking in with vet, 
incase any complication or sign infection that req additional meds