C09993608 / invoice 10000

Reason: Dirty Ears CCCB + Cytopoint CCCBAppointment Notes: Owner has been cleaning them but doesnt seem to help. Shaking head  ------- Sms reply: YHistory:Done by TOSShaking ear for a week, not constantlyO cleaning ears with EpioticScratching occasionallyMostly leftEDDUNo V+ Or D+UTD Parasite PreventionSkin Examination – Third and Subsequent ConsultationsProvisional diagnosis:Bilateral bacterial otitis externa (rods) secondary to underlying atopic dermatitis. Recurrent ear infections are a manifestation of uncontrolled skin allergies.Other diseases still under consideration:- Pseudomonas otitis- Malassezia overgrowth (secondary)- Foreign body- Underlying food allergy- Ear canal stenosis- Otitis mediaLong-term management plan:The long-term strategy involves managing the underlying skin allergies to prevent recurrent otitis. The Cytopoint injection interval will be adjusted based on seasonal flare-ups and clinical signs, shortening from 5-6 weeks to 4-weekly during summer months (until April) to pre-empt inflammation. Apoquel is contraindicated due to a history of a mast cell tumour. Short-course prednisolone therapy will be used to manage acute flare-ups, as this approach carries a lower risk of long-term side effects compared to continuous steroid use. Regular maintenance ear cleaning with Epiotic wash is also a key component of the plan.Actions for Today:- Prednisolone tablets: Administer a tapering dose for 12 days, starting with twice daily, then once daily, then every second day.- Mometamax ear drops: Apply to both ears twice daily, commencing tomorrow.- Cytopoint injection: Reduce interval to every 4 weeks until at least April to manage seasonal flare-ups.- Epiotic ear wash: Commence twice daily cleaning from tomorrow. A 30-minute interval is required between cleaning and Mometamax application. Once the current infection resolves, continue maintenance cleaning once every two weeks.- Diet: Continue current Royal Canin diet without changes.- Monitoring: Annual blood tests are recommended to monitor liver, kidney, and pancreas function.Re-check consultation scheduled in 5 days to assess response to treatment before the prednisolone course is finished.If pruritus or head shaking returns, the owner should bring forward the next Cytopoint injection, adjusting the interval from 6 weeks to 5 or 4 weeks as needed to prevent a full flare-up. Short bursts of prednisolone may also be considered for flare-ups.Next appointment on 11/03/2026.    Vital Signs    Weight: 23.4;