C10003500 / invoice 10000

Appointment Reason: 1.2 CONSULT 2, Appointment Notes: 7 day rv with vet ears ML  ------- Sms reply: YesSubjectivePresenting Concerns:-   Bella presented for a recheck of her ears. The owner reports she is shaking her head less frequently.  Historical Conditions:-   History of brachycephalic obstructive airway syndrome surgery (nares and soft palate).  Diet/Appetite:-   Eating normally.  Drinking/Urination:-   Urination and defecation are normal.  Skin & Coat:-   Receives an injection for skin allergies q 6 weeks.-   Owner reports she gets smelly quickly and skin can flare up in muggy weather.  Current Medications:-   Cytopoint injection q 6 weeks.Targeted exam:ObjectiveMentation: BAR  Wt: 11.3BCS: 6/9  T: Not taken  P: WNL  R:PantMM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: Excited  Eyes: Clear. No discharge or erythema OU.  Ears: The AD canal is very erythematous and irritated on examination. The AS is less affected. A greasy discharge is present in left ear (poloxamer residue), right ear lots of thick brown discharge still.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: Calculus and gingivitis absent. No masses or other lesions.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, mild yeasty smell. Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   Ear Cytology: The infection has improved since the last visit. The AD still contains some cocci bacteria and a reduced amount of yeast.AssessmentOtitis Externa, Bilateral - Unresolved infection, more severe in the AD. The condition is likely secondary to underlying allergic skin disease.PlanMedications/Treatments:-   An ear clean was performed in-clinic.-   A second dose of a long-acting EKT medication was administered to bilaterally.-   The owner was quoted $368 for today's consultation, cytology, and treatment, which they approved.  Additional Discussion:-   A recheck examination is scheduled for next Thursday to assess response to treatment.-   Discussed that if otitis recurs, a preventative ear cleaner may be prescribed.-   If the condition does not resolve or continues to recur, a sedated ear flush will be recommended.    Vital Signs    Weight: 11.3;