C10015087 / invoice 10000

11/03/2026 
Current diagnosis:
Current status:
Current treatment plan:
Current diet:
Other medical history:


History
Age of onset: on and off for a few years
Seasonality: non seasonal worse in Summer
Lesions: erythema
Distribution: ears and feet
Gastrointestinal signs:nil
Any affected in contact/related pets and humans: nil

Environment:
Indoors: mostly
Sleeping arrangements: owner's bed
Previous treatment and response: nil currently

Diet: biscuits and wet food
Previous elimination diet: RC Anallergenic no improvement

Other medical history: 
Previous ciclosporin 50mg capsules once a day resulted in diarrhea
Cardiac disease had echo at Animalius and receiving pimobendan (last performed July 2024) 
Fluoxetine for dog aggression

Physical examination: limited exam due to temperament; both ears moderate stenosis with greasy to purulent material (worse right)
 
Diagnostic test results
Cytology
Left ear: 1+ cocci, 1+ rods/HPF
Right ear: 1+ cocci, 1+ rods/HPF
Recommended diagnostic tests
General anaesthesia for video-otoscopy exam and flush
Left and right external ear canal bacterial cultures and extended antibiotic susceptibility testing
+/ CT to evaluate middle/inner ears (one episode of nystagmus)

Diagnosis
End stage chronic bilateral otitis with polypoid masses +/- media due to environmental allergy-evident by summer flares
With concurrent food allergy (chicken)
Cardiac disease receiving pimbendon
 
Treatment plan:
1.Symptomatic anti-itch and anti-inflammatory therapy
Increase prednisolone 5mg tablets; 2.5mg orally once a day for 4 to 6 weeks until ear procedures before reducing to 2.5mg orally every 2nd day
Continue ciclosporin (Atopica/Neoral) 100mg/ml; 37mg (0.37ml) orally once a day ongoing. This medication interacts with pimobendan
Monitor for gastrointestinal (mainly vomiting, diarrhea), gingival hyperplasia and hirsutism side effects. Do not allow to hunt and no feeding of raw meat. 
Give preferably 2hrs before or after food to improve bioavailability
2.Symptomatic antimicrobial therapy
Nil
3.Elimination diet for food allergy
Recommence strictly Prime 100 kangaroo and pumpkin for now. 
4.Allergen specific immunotherapy
The allergy vaccine is the only treatment modality that can modify the underlying allergic disease, reduce overall itch level, control against reinfections and reduce the amount of anti-itch medications required. The vaccine will take up to 6-9mths to take effect and we have a 70% success rate. If Simba improves, then they will stay on the vaccine for about 3 years
5.Ear therapy
Nil until ear procedures
Recommend bilateral TECALBO surgery. Derm to submit histopathology and middle ear bacterial culture and extended antibiotic susceptibility testing
6.Pain relief
Continue paracetamol 48mg/ml (no xylitol); 2.2ml (105.6mg) orally twice a day as required
7.Calming medication
Continue fluoxetine
 
Revisit: We would like to see Simba in 3months, earlier for ear procedures
Future plan":
1.Simba is flaring in his ears and skin itch. We recommend increasing the prednisolone dose and recommencing strict elimination diet.
2.We have recommended surgery for longer term management of the ear disease. As Simba can still hear, owner is keen to avoid surgery. We would therefore recommend repeat video-otoscopic flushes every 6 to 12mths and to consider CT due to recent single episode of nystagmus, which may indicate middle/inner ear disease.