C09998211 / invoice 10000

Appointment Reason: 1.4 CONSULT 4, Appointment Notes: Recheck ears/poloxymer - may need to be admitted for sedation pending behaviour. GLAppointment Reason: 1.4 CONSULT 4, Appointment Notes: Recheck ears/poloxymer - may need to be admitted for sedation pending behaviour. GLHISTORYATTENDING VET: Dr Rachel Bush-King, BVSc (Hons) GPCertSAM  Presenting Concerns:-   Skittle presented for a recheck of bilateral otitis externa, 7 days after a sedated ear flush and treatment. The purpose of the visit was to assess progress and determine if a second dose of Poloxamer medication was required.  Current Medications:-   Prednisolone was administered prior to an ear flush procedure 7 days ago.-   Poloxamer both ears at time of ear flush 7 days ago.  Additional Information:-   Skittle was sedated 7 days ago for a bilateral ear flush for otitis externa.-   At that time, 2.5 mL of a long-acting ear gel (Proloxima) was administered into AU.-   Initial ear cytology revealed a Malassezia yeast infection, graded at 2+ in AU.-   He required a muzzle for the initial examination and cytology.-   The O reports that Skittle has been doing well at home with no head shaking or scratching observed.-   The O notes that Skittle is generally tolerant of ear handling when not in pain. They clean his ears 1-2 times per week.PHYSICAL EXAM-   Ears: The patient was sensitive to ear examination. An attempt to perform otoscopy was unsuccessful as the patient would not tolerate the otoscope. The external ear canals were able to be swabbed for cytology.  Diagnostics:-   Ear Cytology (Bilateral): Malassezia yeast present at 1+ in AU. This represents an improvement from the 2+ infection level noted 7 days prior, but indicates a persistent infection.ASSESSMENTProblem List1.  Bilateral Otitis Externa (Malassezia) - Persistent yeast infection despite initial treatment 7 days ago with a sedated ear flush and application of a long-acting medicated gel. Cytology today confirms improvement (Malassezia reduced from 2+ to 1+), but the infection has not fully resolved. The patient's temperament precludes a complete otoscopic examination or in-consult treatment without sedation.PLANClient Communication:-   Discussed the cytology findings, confirming that while the yeast infection has improved, it is still present. Explained the necessity of a second treatment dose.-   It was recommended that Skittle be sedated again to allow for thorough cleaning of the ear canals to remove debris, which is crucial for the medication to work effectively, followed by the application of the second dose of the long-acting ear gel. An estimate for the procedure was provided at approximately $650.-   A detailed discussion was had regarding long-term management to prevent recurrence. This included a preventative protocol of weekly ear cleaning, alternated with the application of a maintenance ear solution containing both anti-inflammatory and antifungal components. It was emphasized that this preventative plan should only be started once the current infection is confirmed to be completely resolved.  Medications/Treatments:-   Skittle was admitted to the hospital today for a sedated procedure. The O confirmed he was fasted this morning.-   A signed consent form was obtained.-   The plan is to perform a sedated ear clean and administer a second dose of the long-acting ear medication into AU.  Ongoing Plan:-   For long-term prevention of recurrent yeast otitis, a maintenance plan was recommended to begin after the current infection is resolved.-   The plan involves cleaning the ears once weekly (e.g., on a Wednesday).-   On a different day of the week (e.g., on a Sunday), a combination Cortavance / Austrazole ear solution should be considered to help control inflammation and reduce the yeast population. This should be discussed again and prepared at next revisit.  This document was generated with the assistance of CoVet AI to support accurate and efficient documentation.    Reviewed by: RBKProcedure report TSBSedated with 0.3mg/kg butorphanol and 10mcg/kg domitor. Ears cleaned with otoflush. 4ml poloxamer instilled into each ear. Reversed with same volume antisedan as domitor.     Vital Signs