C10013461 / invoice 10000

Verified: YesHISTORYPresenting for: Ear infection. Patient presented with a malodorous ear discharge for approximately one week.Historical Conditions: Previous ear infection in July 2024 with bacterial and yeast components.Current Meds: Using ear cleaner.Other: Owner reports the current infection is not as severe as previous episode, which was really bad and really smelly.EXAMEars: Bilateral otitis externa. Veterinarian recommends using different tips for left and right ears to avoid cross-contamination.Diagnostics: Ear cytology performed - mixed infection with bacteria present.Right - yeast / rods and cocciLeft - cocciASSESSMENTOtitis externa - Mixed bacterial infection present bilaterallyPLANMedications/Treatments:- Aurizon prescribed for 10 days. Start tomorrow, can be administered morning or afternoon (as first dose given today)Additional Discussion:- Discussed potential causes of recurrent ear infections including allergies, environmental factors, and dietary components.- Recommended acetic boric acid ear cleaner once infection clears.- Advised to use ear cleaner prophylactically after swimming or beach visits.- Instructed on proper administration technique for ear medication, emphasizing the need for a thorough application.Client Comms:- Follow-up recommended in 10 days

Owner: Emma (and baby)History:Noticed irritated by ear again and ears smell.3rd ear infection in the last 4 months.Last one resolved with pred + dermotic and advised cleaning out weekly with acetic/boric acid and dex. Have not been cleaning regularly. EDDU normally, no vomiting.Occassionally has loose stools and sometimes chews paws and is also bum scooting.Diet - Eukanuba kibbleExam:Mentation - BAR, very good dogCardio - No murmur or arrhythmia, HR 90Resp - Normal lung soundsEyes - Clear, no reddening or dischargeEars - Left ear: pinna very inflamed and erythematous, malodourous, light brown discharge, irritated and painful when examining, cytology - yeast ++, cocci +. Right ear: not inflamed or erythematous, minimal discharge, cytology: clearAbdomen - Soft and comfortable on palpationAnal glands - only slightly full, expressed easily with normal anal gland dischargeAssessment:Otitis externa - left ear (opposite to last time)Plan:- Dermotic - 1mL to left ear BID for 10 days.- Pred - 20mg for 4 days, then 10mg for 4 days, then 10mg EOD- Advised to do weekly ear cleaner with acetic/boric acid and dex as previously advised by JLT.- Also mentioned anti-pruritics (apoquel, cytopoint) and a diet elimination trial as suspect underlying allergies. Owner will consider once ear infection clears up but thinks elimination diet will be difficult to do properly with young children.Recheck ears in 10 days.31/7 ncb n/a sent txt and survey mc

owner spoke to lou - left ear has flared up , last seen last month with yeast otitis in r ear. given dex in ear cleaner to use long term and course of dermotic.recommend r/v