C10012083 / invoice 10000

Appointment Notes: recheck jc- LFL raised red lesion in between P3-P4. Poorly defined. - L ear some cocci ongoing, no rods- applied osurnia L ear- recc malaseb 1-2 times weekly on LFL and neocort BID 5 days on LFL lesion- O consented to external cytology for LFL lump- recheck ears in 2 weeks.Verified: NOHISTORYPresenting for: Ollie, a pug, presented for recheck of ear infection and evaluation of ongoing redness on front paw.Historical Conditions: Previous ear infection with rod bacteria and cocci. Chronic redness on front paw with intermittent white discharge. Broken tooth found in bed after previous visit.Diet: Started hypoallergenic diet Friday night last week. Eating normally.Current Meds: Topical ear drops (medicated) - owner had difficulty administering drops, resorted to applying medication on cloth and inserting finger into ear canal.Skin: Chronic redness on front paw with raised appearance, sometimes with white discharge. Owner admits to being less diligent with cleaning recently.EXAMBehavioural: Cooperative for examination. Does not like ear drops but tolerates finger insertion into ear canal. Required restraint for paw sampling.Ears: Left ear infection improved. Microscopic examination revealed resolution of rod bacteria with minimal cocci remaining.Integumentary: Right front paw shows raised, erythematous area consistent with folliculitis. Borders are indistinct, not discrete lump-like. Area has deeper inflammation of hair follicles and skin layers.Oral: Fractured tooth noted - portion found at home by owner.Diagnostics: Ear cytology - rod bacteria cleared, minimal cocci present. Fine needle aspirate of paw lesion - no mast cells identified, consistent with chronic inflammation. Predominantly histiocytes present with some cells showing binucleation suggestive of reactive changes.ASSESSMENTOtitis externa - significant improvement with resolution of rod bacteria, minimal residual cocci infectionFolliculitis right front paw - chronic inflammatory condition, likely infectious componentFractured tooth requiring extractionPLANMedications/Treatments:- Long-acting ear treatment administered in clinic to resolve residual cocci infection- Fine needle aspirate performed on paw lesion with topical anaesthetic (Emla cream)New Meds/Tx:- Topical antibiotic cream (thick consistency suitable for ocular use) for paw lesion, twice daily for 5 days- Malaseb medicated shampoo for paw, up to twice weeklyDiagnostics:- Cytology sample from paw lesion submitted to external laboratory for definitive diagnosis ($247) - 80% confident of inflammatory process but some atypical cells warrant further evaluation- Dental extraction quote to be resent to ownerDiet Recs:- Continue hypoallergenic diet- No treats from clinic due to dietary trialAdditional Discussion:- Owner reports difficulty administering ear drops, found alternative method using cloth application effective- Paw condition has been chronic with periods of neglected cleaning- If paw lesion doesn't improve with current treatment, consider oral antibiotics or repeat sampling under sedationClient Comms:- Ear infection significantly improved, long-acting treatment should resolve remaining bacteria- Paw lesion sample sent for analysis, results to be communicated when available- Recheck appointment in 2 weeks to ensure ear infection fully resolved- Dental quote to be resent for fractured tooth extraction- Insurance claim to be processed    Vital Signs    Weight: 11.2;