C09993990 / invoice 10000

Reason: Re Check Appointment Notes: Overdue remindersVerified: NoReason: Ear treatment follow-up and HW prevention discussionHistory:Currently using Elocon drops in ears - L ear and R earOwner reports dog started scratching one ear again last nightHas been managing ear condition with weekly treatmentsExamination:BAR in consultMMs: pink & moist, CRT < 2secEars: Both ears look fantastic, no thickening, anger or redness, ear canals open wellCardio: no murmur or arrythmiaResp: Lung sounds clear, normal respiratory effortAbdo: comfortable on palpation, no palpable massesIntegument: NADLNs: normalAssessment:Ear condition responding well to treatmentDue for HW preventionPlan:Continue Elocon drops once weekly in both earsReduce frequency over cooler months if coping wellResume weekly treatments approaching spring/summer seasonDiscussed HW prevention options - Bravecto chews E3M or Proheart SR12 injection yearlyConversation with owner:Advised not to clean ears unless excessive wax presentExplained Elocon reduces inflammation to prevent Malassezia overgrowthDiscussed trial of extending treatment intervals if ears remain stableOwner to monitor for early signs of irritation or rednessHW prevention decision between Bravecto chews E3M or yearly injectionCan coordinate Bravecto with Drontal worming E3M if preferred    Vital Signs    Weight: 11.8;