C10010756 / invoice 10000

10/03/2026 NURSE: LM

REASON: Concern re R ear - smelly discharge since Friday.

HISTORY:
- Seen by Dr Russell Friday for dental recheck and ear check. Ears flushed under anaesthetic. L ear - small polyp noted, not causing issues. R ear - inflammation and discharge. Unknown mass/corn noted in R ear? noted by holistic vet.
- After starting dermotic on friday - gunk and strong smell from R ear. Continued over weekend.
- On dermotic ear drops BID. Started 06/03/2026. Previously on same drops from 16/02/2026, stopped ~1/52 before dental.
- Rubbing R ear, licking paws more since surgery.
APPETITE: Good
CURRENT MEDICATIONS: Dermotic ear drops BID (R ear), meloxicam SID

CLINICAL EXAM:
- Mentation: BAR
- MM: Pink, moist
- CRT: 1 sec
- Oral and Dental Score: suture present L side
- Eyes: Clear
- Ears:
R ear - marked inflammation and ulceration throughout entire canal, TM intact. Cytology: bacteria +++
L ear - clear
- BCS: 4/5
- Abdominal: soft and comfortable
- Lymph nodes: NSF
- HR: NAD on ausc
- RR: NAD on ausc

ASSESSMENT:
- R ear - severe inflammation and ulceration throughout ear canal. Likely reaction to dermotic. Ear drum intact. Swab taken - bacterial infection noted.

DISCUSSION:
- Owner advised likely reaction to ear ointment causing inflammation. Can happen even if previously tolerated.
- Discussed Prednisone course to settle inflammation, need a washout period from NSAIDs before starting.
- Side effects may include increased drinking and urination - will resolve as dose reduces.

TREATMENT:
- Changed to dex/enro/keto 1ml into right ear (slow-release ointment) - one dose today. Different steroid, better antibiotic coverage.
- Prednisone: 5mg tab SID x 4/7, then 1/2 tab SID x 4/7, then 1/2 tab every other day.

PLAN:
- Nurse appt 17/03/2026 at 11:30 for second dose of ointment.
- Recheck with Dr Russell 24/03/2026 at 16:30 - swab and reassess.
- Cancel Friday appt with Dr Russell.