C09992417 / invoice 10000

05/03/2026 NURSE: RW 

REASON: F/U ear tx + skin concerns

HISTORY:
- Completed abx course - no side effects
- Finished ear meds
- Malaseb washes done at home
- Chin area dry - used Malaseb ~2/12 ago, may have caused dryness
- Feet improved re: dryness
- Less foot licking noted

APPETITE: Not mentioned
ACTIVITY: Not mentioned
DIET: Not mentioned
TOILETING: Not mentioned
CURRENT MEDICATIONS: Malaseb washes, Cytopoint monthly

CLINICAL EXAM:
- Mentation: BAR
- MM: pink
- CRT: 1s
- Eyes: clear, mild dried discharge bilat
- Ears: L ear - mild wax, ear canal NAD; R ear - clear, healthy
- BCS: 3/5 
- Abdominal: Nad
- Skin: Feet - skin healthy, improved; chin - dry; lip fold dermatitis present, mild

ASSESSMENT:
- Ear cytology: debris only, 1 bacteria in one sample - NAD
- Lip fold dermatitis mild 
- Chin/feet dryness - likely Malaseb stripping oils

DISCUSSION:
- Discussed ear cytology results - normal, no concerning bacteria
- Advised conditioner use 1x/wk to rehydrate skin
- Coconut oil ok to use for dry areas
- Recommended omega 3 supplements for coat health
- Elicon discussed - topical steroid to reduce inflammation + prevent infections
- Advised Otoflush after swimming to remove seawater/debris

TREATMENT:
- Cytopoint injection given today
Cytopoint 20mg 
Batch: 806983
Exp: 12/26

- Otoflush dispensed
- Elocon dispensed - 0.5ml each ear after every flush, once weekly 

PLAN:
- No ear tx for 1 week, then Otoflush
- Wait 3 mins, then Elocon 0.5ml each ear
- Repeat in 1 week
- After that, every 3 weeks
- Continue monthly Cytopoint
- Use conditioner for dry areas
- Spot tx Malaseb face/chin
- RTC if worsening skin or ear issues