C10008507 / invoice 10000

Reason:  
History: 
Seen a month ago for ear issues, R was problem at the time.
Declined cytology and did not return at end of course to reassess
Owner has been doing BID flush and dermotic BID as per last visit. Halfway through course the left ear started flaring so owner repeated the above plan. 
Owner doesn't think L is any better but is not bothered with R ear. 

EDUF normal

Current medications: insulin 4IU BID and apoquel 5.4mg SID

What Preventative health cover is being used and do you need to purchase any today? UTD monthly and tapeworm 3 monthly

Examine: 
Mentation: BAR
Body condition score: 5/9
MM:      PM          CRT:  <2s
HR:        140        RR: panting
LN: wnl
Temperature: ne

Ocular: bilateral cataracts
Oral/Dental stage: grade 2
Ears: right ear not inflamed but resistant to otoscopic exam, left ear inflamed, TM intact, no FB present in the ear, minimal discharge
Cardiovascular: no murmur or arryhthmia
Respiratory: normal lung sounds
Gastrointestinal: soft and comfortable
Integumentary & lumps (measurement, location): nad
Musculoskeletal: nad
Urogenital: nad
Neurological: nad

Assessment: 
Ear irritation
- discussed cytology, advised if have bacilli bacterial infection then dermotic may not be suitable, owner consented

In house ear cytology
- right ear: no bacteria and only 1 malassezia observed on sample
- left ear: no bacteria noted, mild malassezia overgrowth

Treatment: 
Discontinue dermotic in the right ear
Continue dermotic BID in left ear 7-10d. 
Clean ear with otoflush once a day twice a week for now then reduce to fortnightly, suspect BID cleaning irritating ear. 

Plan: 
Recheck ears 14d

Reason: Courtesy phone call 
Nurse: ep

History: R ear issue 
     Demeanour: bar
     Eating/ Drinking: yes
     Toileting: yes
     Any concerns? 
     
Treatment:
     Medications being given: Dermotic drops 3-5 drops 
     Patient taking meds as prescribed? yes

Assessment: O has not seen her this morning but think she's doing better.
- will call back if any concerns 

Next Appointment: end course revisit