C10007309 / invoice 10000

History: Concern abou tL ey enot being able to blink - noticed last 2 daysOn questioning, owner thinks lip may have been droopy since last visitEDDU normalRunning around]no obvios uear irritationExamination: BAREyes clearEars: R clean, tympanum normalL marked greasy wet discharge, unable to view tympanumNo blinkin response L ee, 3rd eyelid blink presentDrooping L  lipNo motor response to touching L lip and L whiskers, normal R sideNormla gait, normla responses forelegs, althoguh nails are worn from scuffing both forelegsHR 100 no murmursLaboratory: Collect sample for TAHP (inc T4)Ear cyto: occasioanl mallaseziaModerate cocci present from deep ear swab2+ neutsSubmit deep swab for culturePlan: admit for ear cleaning (undersdation if needed)Able to flush ear without sedtion, flushed with saline and feding tube with otoscope guidanceremoved all debris down to tympanum - typanum not presentThickened white crusty material lining ytympanic bullae - unabel to remove with flushingAssessment: Facial nerve apralysisL ear otitis mediaHigh chance facial nerve paralysis may be related to otitis mediaTreatment: use tear replacement in L eyePred 5mg sid for 5d, then 2.5mg sidCephalexin 150mg bid for 2 weeksContinue itranoxPlan: Revisit in 5-7 dys to assess ear + flush again if requiredReport culture results when vailable (expect 48 hours)    Vital Signs