C09997522 / invoice 10000

Reason: Ear FlushAppointment Notes: Special payment terms existDifficult to examine- growling and snapping. Premed: 0.4ml dom 0.4ml methadone IM, no response initially, might have gone into fat. 0.4ml dom IM repeated into thigh muscle some moderate sedation achieved. Surgery: Alfaxan top ups used. R ear looks great, clean down to ear drum. L ear very dirty brown waxFlushed with video otoscope down to level of ear drum, quite a lot of hair and yellow wax entrapped on top of ear drum. Removed as much hair and wax but did not want to damage ear drum Cytology: L ear yeast ++++ cocci++++  R ear clear.Knots brushed out Instilled 2mls of poloxamer gel. Then in 7d will clean out in consult and instill 2ml more.Give traz and gaba before next consultContinue on 10mg/day of pred till then (2 tablets)    Vital Signs    Weight: 25.75;