C10001219 / invoice 10000

Reason: Ears / Itchy / Check UpAppointment Notes: Paws App Details:Booking Type: Consultation Ear/Eye/Skin ProblemBooking Vet: - Any -Booking Notes: Check up on itchy earsPet Insured: YesHISTORYSkin: Patient has been scratching ears intensely, kicking at them when agitated. Client reports occasional scratching when weather changes but nothing to this extent previously. No previous medication required for skin issues.EXAMWt: 8 kgBehavioural: Nervous dog, particularly anxious about ear and dental examination.Ears: Inside of pinnae inflamed on both sides - red and scapey. Left ear significantly more waxy with malodorous discharge compared to right ear. Right ear appears clearer with minimal discharge.Diagnostics: Ear cytology performed - overgrowth of Malassezia identified in left ear sample. Right ear cytology clear.ASSESSMENTOtitis externa - Malassezia overgrowth in left ear secondary to underlying allergic dermatitis. Bilateral ear inflammation present with unilateral yeast infection.PLANNew Meds/Tx:- Prednisolone tablets: 1 tablet once daily for 4 days, then 0.5 tablet once daily for 4 days, then 0.5 tablet every second day (tapering course). Cost approximately $40 for 12 tablets. Client advised of potential side effects including increased appetite, drinking, urination and short-term behavioural changes.- Dermotic ear drops: Apply to left ear twice daily for 10 days.Additional Discussion:- Discussed Apoquel as alternative anti-inflammatory option ($112 for 2-week course, 1 tablet twice daily for 7 days then once daily for 7 days) but client opted for prednisolone due to cost and acute nature of condition.- Explained likely allergic aetiology triggered by environmental allergens, creating favourable conditions for secondary Malassezia overgrowth.- Discussed potential for chronic/recurrent nature of allergic ear disease requiring ongoing management.    Vital Signs