C10006649 / invoice 10000

Ears

History: Shaking head a bit, otherwise well, no concerns. O does not want to continue with cartrophen as she wants natural sup[plement instead. Zaus (and the rest of the family) are all taking some sort of oil supplement? Discussed and recommended supplements specifically for dogs instead, eg. 4cyte. 

CLINICAL EXAM: 
Left ear: WNL, mild cerumen in canal but no inflammation
Right ear: WNL, mild cerumen in canal but no inflammation

TREATMENT:
Nil indicated. Cleaned both ears with epiotic SIS.

R: Cartrophen

H: 15d since 2nd loading dose... Ideally should start over loading period with 4x injections 5-7d apart if following manufacturer guidelines. Other option is inj today and in 1w but may not have as good effect. O is not sure what she wants to do. Agreed that we will do one inj today, book the 2nd in a week and discuss at that appointment if we should do two more loading doses (strongly recommended), or go over to monthly/trimonthly regime. 
Ears have been good but o wants quick check. 

E: Ears have no smell, scoped WNL. 

T: 0.23ml Cartrophen/Synovan SC

P: Starting over loading period, 2nd dose in 1w and two doses following q1w after this. 
O requested more dermotic as she uses this sporadically for both dogs. Strongly advised against this in regards to antibiotic resistance development, o understands and will use non medicated cleaned for maintenance. 

No show for cartrophen inj today. TTPONALM & sent sms - rec o to call back to book this in as has only had 2 of the 4 loading injs so far.