C09991842 / invoice 10000

05/03/2026 NURSE: MY

HISTORY:
- 2nd episode of ear issues
- Previous Tx for demodex
- Occasional head shaking post ear cleaning
- Significant improvement noted

TOILETING: Not assessed

CLINICAL EXAM:
- Ears: Some wax/gunk present, NAD otherwise

ASSESSMENT:
- Ear wax build-up
- 2nd ear episode

DISCUSSION:
- Owner advised on ear cleaning technique
- Apply ear cleaner, massage, soak, clean with cotton bud/gauze
- 1-2x per week to break down waxy build-up
- Waxy build-up can block ear canal ? warm/closed environment ? bacterial growth
- If recurrent, consider ear maintenance meds
- Ear cleaner options: Otoflush (good for sensitive skin), Epiotic (drying agent, good for dogs that swim)

TREATMENT:
- Ear cleaning at home 1-2x per week

PLAN:
- Purchase ear cleaner from pet store
- Monitor for recurrence
- RTC if issues persist