C10013485 / invoice 10000

Reason: After OsurniaAppointment Notes: Special payment terms existHistory: Brought in by male O + daughterPossibly still scratching ears + around vulva- no change in amt of licking Have been careful to keep out of the water2nd osurnia into both ears 19d ago.Clonidine only been used twice, at a dose of 450ug total- no effect (suspect this is not enough for her) Clinical Signs: Very excitable, but O's seem to have more control of her than prev records suggest.Focussed exam- external ears appear grossly quite clean (no otoscopic exam today)Vulva: a little hooded, mildly hyperpigmented/thickened skin, no redness, no infmallation, no moisture, but some alopecia present.Laboratory: L ear (was 2+ yeast): 2 yeast seen across slideR ear: (was 1+ yeast): 1 yeast seen across slide.Assessment: Ear infection resolved.Vulval irritation- possible UTI.V's atopyPlan: Discuss cytopoint and apoquel- O's keen to trial hypoallergenic diet prior to considering allergy meds.Discuss anallergenic/z/d, also mention 6-8wk trial required. O's to drop in urine sample to rule out UTI    Vital Signs    Weight: 26.4;