C10008584 / invoice 10000

WEIGHT: 5.2
SUBJECTIVE: O reports that there has been irritation to the head and skin again, previous noted may be mange, treated previously but still has some issues. 
On diet of dry and wet whiskers. 
Indoor outdoor cat. 

PE: 
Excoriations on the top on the head, and scratches on the ears. Mild discharge in the ears but not infected. 
No other wounds on the body. 
MM pink and moist
CRT 1s
HR 160
RR NAD
Abdomen soft NAD
Derm - as above. 
Ears - No notable infection, mild ceruminous liquid from the ears. 

Ddx: Allergic dermatitis, cat fight wounds, food based allergy. 

Tx: Redipred home and then O to treat skin with betadine. 
If no improvement then needs review. O has given 3 monthly ectoparasitic.

SUBJECTIVE: O presented previously for suspicion of mange, treated but O thinks still losing hair and there are some scabs she wants checked. 

DH checked and there is some bites on the ears, and some flea dirt. Was given bravecto only a couple of days ago. 

Suspect mosquito bites or fleas, cant findd any fleas. O thinks mosquitoes present. Dont think mites. 
O to continue bravecto ongoing. To keep indoors for the next 2 weeks to allow to heal. Advised to get pest inspector out to spray.

HISTORY: Presenting issues:

History: O reports that cat has gunky ears and eyes and that he has been sneezing a lot. EDDU normal. No CSV+D+. Treated with nexgard spectra for cats as the dog reportedly had parasite issues i.e. mange. 


Examination: 
PE unremarkable except
- bilateral dark waxy dx in ears
- green dx from both eyes but no slceral injection
-Temp 38C    

Ear cytology
- L ear: yeast +++ cocci ++
 - Rear: yeast +++ cocci +

Differenital diagnosis and client discussion: 
- ddx: cat flu vs URI 
- also secondary conjunctivitis bilateral infectious
- ears infected 
- recommend PMP both ears 
- recommend vibravet + chlorsig 
- revisit in 14 days
- if no improvement next steps bloods + chest rads
- keep indoors for 2 weeks 

Tests/treatments:
- cleaned ears 

Medication:
- tricin both eyes BID x 7 days
- vibravet 1notch PO BID x 3 days then 1 notch PO SID until finished w/food
- PMP 0.5ml both ears BID x 14 days 

Plan:
Revisit  Y in 14 days
WEIGHT: 5