C09992646 / invoice 20000

04/03/2026 Reason: Check ears
History: Much better on the apoquel compared to cytopoint. So recheck for new script for that. Also scratching at ears, to the point of whining. Not as bad as used to have. O hasn't seen any discharge in the ear either.

Examine: BAR
Limited exam as very excitable. Less mouthy and no nipping in consult. Much better behaved but still boisterous.
Ears: severe erythema both ears. No visible debris but unable to examine with otoscope due to behaviour. Swabs taken and both have significant amount of black brown waxy debris. 
Cytology: both mainly debris 4+ with malassezia 2+ and scant bacteria. No visible RBCs or WBCs
Skin: slightly pink on lips, eyelids and nose but otherwise no visible erythema or lesions on skin. No pruritus in consult and no visible scratching marks or sores anywhere. Significant improvement. 

Assessment: Bilateral otitis externa

Discussion:
Explained risks of putting topical ear medication in ears when unable to confirm if ear drums intact. O's understand and opting to try the topical medication anyway. Any signs of severe head tilting, pain, loss of balance etc will bring her back in asap. Otherwise happy with medicating. Also recommended ear cleaner, O's already have otoflush for their other dog so recommended once weekly ongoing to help reduce infections. 

Treatment:
Dermotic both ears BID for 10 days.
Script for apoquel dispensed. 

Plan:
Recheck ears in 10 days.