C09996501 / invoice 10000

Subjective: Dash presented for an ear recheck. Initial treatment began May 19th with an ear flush and medications, but owner compliance with follow-up was poor. Patient returned June 5th with a severely macerated ear and received Neptra treatment. The ear has been chronically thickened and stenotic. Patient has gained 1kg (3% body weight) in the past 4 weeks following a diet change to a sensitive skin formula 10-15 days ago. No previous history of ear infections noted. Patient is currently on a sensitive skin diet to address itching around elbows.Objective: Temperature: Normal on examHeart Rate: Normal on examWeight: 33.2 kgRespiratory Rate: Normal on examCapillary Refill Time: Normal on examMucous Membranes: Normal on examHydration Status: Normal on examBody Condition Score: Normal on examPain Score: Normal on examFear Anxiety Stress Score: Normal on examEyes: Normal on examEars: Right ear shows more redness compared to left, both ear canals slightly red, presence of dry crusty skin cells, discharge is dryNasal: Normal on examOral/Dental: Normal on examCardiovascular: Normal on examRespiratory: Normal on examNeurological: Normal on examMusculoskeletal: Normal on examLymphatic: Normal on examGastrointestinal: Normal on examReproductive/Urinary: Normal on examIntegument: Normal on examMasses: Normal on examAssessment: - Chronic ear condition secondary to allergies- Improved ear condition with minimal dry discharge present- Weight gain of 3% in past month related to new dietPlan: - Continue current sensitive skin diet but reduce quantity by 5% to address weight gain- Clean ears with Otoflush (pink label) monthly- Proper ear cleaning technique demonstrated and discussed:* Fill ear canal* Thoroughly massage base of ear* Allow patient to shake head* Wipe excess- Swimming recommendations provided:* Use cotton balls in ears before swimming* Consider transition to oil-based cleaner (Sonotics) before swimming- Monitor for increased cleaning needs (more than monthly) or brown discharge as signs of recurrence- Return to clinic if signs of ear infection return

Reason for call: post op follow up call19/05/25 Ear flush & Neptra in R ear under sedationOutcome of call:- EDDU all normal- No current signs of pain/discomfort- Encouraged nil cleaning of ears for a minimum of 30 days as prev. requested - O very worried about head shaking/head tilt as discussed w/ vets as possible side effects, is closely monitoring & will call us with updates & notify us of any changes/other concerns/progressionsO's update @1720:- o called w/ an update - states he has only shaked his head a few times throughout the day, noted nothing excessive- appears to be well overall, O is pleased w/ how he is presenting currently- mentioned they will keep us updated w/ his progression & if they have any concerns before their 2 week reviewFollow up required: Ear Review in 2 weeks (2nd June) to reswab & check inflammation to assess treatment success. Possibility of a second dose of Neptra in R ear dependant on examination. 

- Dash, a 4 1/2-year-old Labrador retriever weighing 32.1 kilos, underwent an ear flush under general anesthesia and received Neptra in the right ear.- The left ear showed minor inflammation and milky ear wax but was relatively clean.- The right ear was severely macerated, inflamed, and had a watery discharge.- It is suspected that the owner's frequent cleaning with a water-based cleaner is exacerbating the ear issues.- The right ear was thoroughly cleaned, and the eardrum was intact despite the maceration and ulceration in the ear canal.- Neptra was applied to the right ear, and the owners are advised not to clean it for at least 30 days.- A follow-up is scheduled in 14 days to assess treatment success, with the possibility of a second dose due to the extent of damage.- Dash was given premedication with DOM and atomidine and required a propofol top-up due to the pain.