C09995993 / invoice 10000

Reason: Re Check Ear Infection Appointment Notes: Special payment terms exist, Overdue reminders  ------- Sms reply: YHistory-Update:History: EDDU OK.Came in for ear re check. On metacam . Richard is not limping currently.On dermotic ear dropsItchy around the eyes, ears . Examination: BAR. Over weightEENT: Bi lateral OE , 10+HPF both sides.CVS: NADLungs: NADMSK sys: NADSkin: mild erythema peri orbital.Assessment: OE  Bi lateral. Emptied AG. R > LMild allergic dermatitis.Plan: Continue dermotic for another 7 days and RV. Start apoquel PO as directedGive metacam only when Richard is in pain or limping.    Vital Signs    Weight: 43.1;       

Reason: Limping, check ears And Anal GlandsHistory: 1) Ears have started getting itchy again over the past week. Richard has a history of getting ear infections, currently has flush weekly for his ears.2) Anal glands - O wants them expressed as he is starting to scoot a bit.3) One week ago Richard was at the beach running and hurt his back left leg. Started limping, but since then has improved dramatically.DUDE otherwise well.Examination: Demeanour: Bright, Alert, Responsive, very friendly boy   	Body condition score:  4/5, overweightMucous membranes:  Pink and moistTemperature:  Not takenEars exam: Both ears moderately stenotic and hyperaemic. Unable to examine otoscope. Moderate amount of waxy discharge.Eyes exam:  NADNose: NADOral exam: Mild tartar on teeth  Dental score:  1/4Chest auscultation: Clear bilateral lung sounds, no HM, normal sinus rhythm  Abdominal exam:  NADUrogenital: NAD	Musculoskeletal exam: A bit tense when touching limbs. Unable to elicit cranial drawer over LHL but allowed palpation without too much pain elicited.Neurological exam:  Good mentationGait analysis: Ambulatory x4, grade 1/5 lameness (toe touching) over LHL. Integument exam:  NADLymph Nodes: NADAnal glands: full. Expressed - moderate amount of brown material bilaterally.Laboratory: Cytology of ears - yeast +++ bilaterally, no obvious cocci or rodsAssessment: 1) Otitis externa2) Injury over LHL - ddx soft tissue injury vs cruciate (however, would expect a more severe lameness and no improvement) vs skeletal vs other.3) Anal glands full - expressed4) A bit overweight)Treatment: Consent has been given by the client to proceed with this treatment  -  YesMeloxicam SID for 7 daysDermotic BID in both ears for 7 days. On revisit, do not add ear drops Plan:Revisit in 7 days to reassess ears and pain over LHL- If no resolution in pain over LHL, then next steps may consider examining and x-rays under sedation.- Anal glands: recommend expressing whenever he starts scooting again- Ideal weight approx. 40kg, advised feeding for around this weight and assessing.    Vital Signs    Weight: 43.5;       

Appointment Notes: Special payment terms exist, Overdue remindersReason: History: Ears a lot better Knee a lot better - very mild soreness remainingExamination: MSK - Mild swelling LHS stifle - no longer painful on extensionEasr = still waxyLaboratory: Ear cytol:One or two yeast otherwise looking goodAssessment: Stifle doing wellOE almost resolvedTreatment: Consent has been given by the client to proceed with this treatment  -  YesPlan:2 more days dermotic then regular cleaning with otoflush    Vital Signs    Weight: 39;