C09997433 / invoice 10000

06/03/2026 History:
- Red eye with discharge, allergies, dragging bum on ground
- Recently moved house this week
- Apoquel ran out approximately 1-2 weeks ago
- Diet: lyka 
- Energy levels: normal, acting like himself, eating well

Physical Exam Findings:
- Behaviour: Good during examination
Eyes: Red, discharge present. Pupils constricting normally. Fluorescein stain negative - no corneal scratches.
Ears: Brown crusty discharge present, yeast infection confirmed. Dark discharge coating ear canal.
Oral Cavity: Not examined.
Abdomen: Anal glands checked - not too bad, right easier to express than left.

Diagnostic Results:
- Fluorescein stain: Negative for corneal ulceration
- Ear cytology: Yeast present

Assessment:
- Problem list:
1. Conjunctivitis
2. Otitis externa - yeast
3. Allergies
4. Anal gland discomfort

Plan:
- Apoquel tablets: Half tablet twice daily until settled, then once daily. Extra dose if more itchy.
- Eye ointment (antibiotic/anti-inflammatory): Twice daily for 5-7 days
- Dermatic ear drops: Two squeezes into both ears twice daily for two weeks
- Ear cleaner: 3-4 times per week initially, then once weekly for maintenance
- Dietary trial: Kangaroo protein only for 6-8 weeks, then rechallenge with chicken to assess for food allergy component
- Recheck in 2 weeks

Communications:
- Discussed food allergy trial protocol - strict single protein (kangaroo) for 6-8 weeks, then rechallenge to identify triggers
- Discussed ear cleaning technique - soft nozzle into ear canal, massage to loosen debris
- Discussed that anal gland issues can be linked to food allergy
- Discussed option for steroid ear drops twice weekly as maintenance once infection confirmed cleared
- Discussed that yeast is normal flora but overgrows when ear canal wet or irritated; allergies and floppy ears predispose to recurrence
- Discussed that weather/humidity this time of year often worsens allergies

SW