C10013493 / invoice 20000

10/03/2026 HISTORY
- Recurrent ear problems with inflammation and Malassezia. Have created a summary of Tx and saved to file. 
- Most recently treated with a 10d course of Dermotic whilst in boarding. 
- Poor response - still very red, irritated ears. 
- Prev treated with Cytopoint, responds but does not last partic long. 
- Food allergy test conducted with no improvement
- Daily chewing of feet noted by O

EXAM
Ears: BOth ears markedly inflamed pinna, Swollen, narrow canals, very red, greasy exudate. 
Cytology - 15 yeasts/ hpf
Feet: Mostly front feet mild-mod red and inflamed, minimal exudate, no lesions
Rest of skin ok

DIAGNOSIS
- Allergic otitis with Malassezia overgrowth, poor response to dermotic
- Responded well to compounded gel with squalene, does not seem to have had Osurnia prev (terbinafine as antifungal)
- Allergic dermatitis

PLAN
1. Administer Osurnia gel in ears, repeat in one week. Advised rpt dose with vet to ensure is responding
2. Switched from Cytopoint to Apoquel, more cost-effectiveness and more anti-inflammatory properties
3  Start Apoquel BID for 2 weeks, then reduce to SID
4. If responding well to Apoquel re feet adn ears - reduce to SID after 2w and cont for at least 1 mth. 

10/03/2026 summary of previous Tx of ears saved to patient documents | 25/02/2026 Kennels dropped in swabs from both ears 
BOTH ears - malassezia 5-8 pHPF 

advise  dermotic BID for 10 days  and recheck in 14 days 

10/03/2026 HISTORY
- Recurrent ear problems with inflammation and Malassezia. Have created a summary of Tx and saved to file. 
- Most recently treated with a 10d course of Dermotic whilst in boarding. 
- Poor response - still very red, irritated ears. 
- Prev treated with Cytopoint, responds but does not last partic long. 
- Food allergy test conducted with no improvement
- Daily chewing of feet noted by O

EXAM
Ears: BOth ears markedly inflamed pinna, Swollen, narrow canals, very red, greasy exudate. 
Cytology - 15 yeasts/ hpf
Feet: Mostly front feet mild-mod red and inflamed, minimal exudate, no lesions
Rest of skin ok

DIAGNOSIS
- Allergic otitis with Malassezia overgrowth, poor response to dermotic
- Responded well to compounded gel with squalene, does not seem to have had Osurnia prev (terbinafine as antifungal)
- Allergic dermatitis

PLAN
1. Administer Osurnia gel in ears, repeat in one week. Advised rpt dose with vet to ensure is responding
2. Switched from Cytopoint to Apoquel, more cost-effectiveness and more anti-inflammatory properties
3  Start Apoquel BID for 2 weeks, then reduce to SID
4. If responding well to Apoquel re feet adn ears - reduce to SID after 2w and cont for at least 1 mth. 

10/03/2026 summary of previous Tx of ears saved to patient documents