C10014290 / invoice 10000

Reason: Ghc, VaxAppointment Notes: Overdue remindersHISTORY:Mable Thorton is presenting today for their final puppy vaccination. There are ongoing concerns regarding intermittent soft stools. The client reports that the stools can be a little bit soft and 'rogue' at times, but not consistently diarrhoeic. Eating, drinking, urinating, and defecating are otherwise normal. There have been no changes since stopping medication last week. A recent dietary change from lamb to chicken flavour of the same brand coincided with some of the gastrointestinal upset.Current diet: Black Hawk chicken dry food.Dental care: Retained deciduous teeth with erupting adult dentition.Vaccination: Due for final puppy vaccination today, but this will be delayed.Parasite prevention: Nexgard Spectra monthly, last given approximately one week ago.Current Medications: None. Recently finished a course of Fenbendazole and Metronidazole approximately one week ago for a previous Giardia infection. A course of Pro-Koln paste was also administered and seemed to improve stool quality.PHYSICAL EXAM:Mentation: BARHR: 140 bpmRR: pantingMM: pink and moistCRT: <2secTemperature: not takenPulses: strong and synchronousThoracic auscultation: no murmurs or arrhythmias, clear lung sounds bilaterallyEyes: no significant findingsEars: The client reports Mable has been shaking her ears recently. On examination, there is some gunk present bilaterally. Otoscopic examination revealed the right ear canal is more inflamed and narrowed with more material present compared to the left. The left ear shows some mild thickening of the canal. Swabs were taken from both ears for cytology.Nose: no significant findingsMouth: can open mouth easily, gag present, no lesions or masses identified. Deciduous teeth present with adult teeth erupting. Abdominal palpation: no mass or organomegaly, no pain or discomfortLymph nodes: palpably normalSkin: clean coat with no significant findingsUrogential: no significant findingsRectal: not indicatedMusculoskeletal: ambulating well, full examination not indicatedNeurological: normal mentation, full examination not indicatedDIAGNOSTICS:Ear cytologyRight ear- Malasezzia >50/hpf; Left ear- Malasezzia ~20/hpfASSESSMENT:Microscopy of the ear swabs confirmed a bilateral ear infection, worse in the right ear. Patient is not suitable for vaccination today due to the active infection.TREATMENT:Dermotic ear drops: 0.75 ml into each ear twice daily for 10 days. The first dose was administered in the clinic.PLAN:The final puppy vaccination has been postponed to avoid overloading the immune system. We will recheck the ears in 10 days, and if the infection has resolved, the vaccination can be administered at that time.The client was advised to continue monitoring stool quality, especially now that the weather is drier, and to report any concerns.The client was counselled that if ear infections become a recurring issue, further investigation into underlying causes, such as allergies, may be necessary, which could involve treatments like steroids.CLIENT COMMUNICATION:The client was instructed on the correct administration technique for the Dermotic ear drops. The importance of completing the full 10-day course and returning for a recheck appointment was emphasised. The rationale for delaying the vaccination was explained and understood by the client.    Vital Signs    Weight: 14.1;