C10013463 / invoice 10000

Reason: Not Better, Uncomfortable + Discharge Appointment Notes: Overdue remindersHistory:Was seen 2 weeks ago Very sore L ear- rods and pus. R ear mild malassezia Was treated with momeomax ultra R ear seems to be going well L ear is however still very sore. Scratching a lot and seems painful, so not really much better. Has been prone to ear infectionsClinical Signs: BAR, a little anxious. R ear- minimal inflammation scant brown discharge L ear - red , uncomfortable but can gently scope- large amt dark purulent liquid discharge in ear canal - cytology shows huge numbers rods and neutrophils still present.Assessment: L ear still very sore and poor response so far after 2 weeks with mometomax ultra Concern re biofilm impeding penetration of gelRecommend EUAx and flush ear canal to give us best change of resolving Discuss may be dealing with stubborn bacteria eg pseudomonasSuggest swab for culture => Owner keen to go ahead. Ate 6 hours ago so o to admit to do this afternoon2pm Anaesthesia: Sedation dom 0.15mL/torb 0.15mL IMGood sedation Mask 02 and monitoring Examine under anaesthetic:R ear  - scoping looks good, skerrick of discharge only L ear- large amount of purulent brown discharge in canal, swab taken for C &S , there are 2 areas at top of vertical canal that are very ulcerated, and the canal is quite red. Able to scope and TM looks intact after flushing ++with saline to remove discharge Assessment:L ear bacterial otitis non respsnsive to mometomax ultra Suspect biofilm playing a role Canal now clear and elect to start on aurizon and otioflush, also pending culture. Treatment:Instil aurizon 0.3mL SID in am Use otoflush to clean ear in pm Demonstrated both of these with owner, gave some swabs Also start on pred due to ear canal inflammation Pred 5mg SID for 7 days then reassess. Discuss SEsPlan:Recheck in 7 days to check progress, call sooner if any concerns Likley call prior when C & S results come to hand.Follow-up: --- 10/03/2026 10:37:44 JCS: left ph msg for post op recovery. JCS.--- 10/03/2026 10:48:06 JCS: PR returned call, going well EDUF and BAR, Gus dif cry when put the first ear meds down, hopefully this lessens as ear infection improves, but PR can call us if needs extra pain relief if ears quite sore still. PR will call back to organise follow up appmt for 7 days and we will call in meantime with lab results. JCS.    Vital Signs    Weight: 7.2;