C10004458 / invoice 10000

REASON: Ears

S: Yamini & Paul presented with Zelda. O ended up only using 7d of dermotic for L ear infection in Jan (as started having v+ / nausea 5d after starting this, o did research and found dermotic poss could cause this, the v+ stopped after stopping). Over last few days shaking head & R ear looks infected now. Not on any current meds.

O: BAR, sweet girl.
Ears:
-L ear: no discharge, no erythema, TM WNL, cytology unremarkable.
-R ear: mild-mod ceruminous discharge, mild erythema with mild pinnae lichenification, no obvious FBs, 1/2 of TM observed and looks okay, cytology showed 30+ malassezia per hpf (no bacteria noted).

A: R otitis externa (yeast)

P: Cleaned with epiotic sis. O keen to trial keto/dex/squalene due to poss dermotic SEs. To provide 0.8ml in R ear for 12d. Recheck in 14d time.

At recheck appt, if infection has resolved to look at commencing elocon as ongoing ear maintenance.
Brief chat about allergy investigation / food trial etc. O will look into this if any skin issues elsewhere or if recurrent ear infections despite elocon.

Doing well. O gave 5d of ear drops but then dog v+ a few times so she discontinued tx by day 7.
O feels ear is much improved.

L ear - beautiful. No inflammation or discharge, TM intact. R ear - nad.
No further tx required.

O reports dog has unusual head tremor since sx last year. Has a video - will bring in to show me, but consider bloods (neuro panel) to further assess;