C10015100 / invoice 10000

Appointment Notes: itched ear too hard and is very redReason: History:Presented for increased scratching this morning, particularly of the right ear. Owner is concerned about a potential ear infection. The patient has a history of atopy and is managed with Apoquel twice daily and chlorhexidine wipes for paws. A previous ear flush was performed approximately 4 months ago under anaesthetic at WAVES. The owner uses an ear cleaner (Epi-Otic) monthly. Paw chewing is also present. The owner reports symptoms are worse in the morning and at night. Otherwise EDUF normal. NO V+/D+Examination:Mentation: Bright, alert, and responsiveHydration status: Mucous membranes pink and moist, capillary refill time <2 secondsCVS: HR: 100. No murmurs or arrhythmias auscultated. Pulses strong and synchronousResp: RR panting. EENO: Both ears appear pink/red externally. The right ear is more inflamed than the left. No ocular or nasal discharge noted. Moderate dental tartar, no oral painPLNs: Peripheral lymph nodes are normal in size and textureAbdominal: Abdomen is soft and non-painful on palpationIntegument: Skin and coat are in good conditionRectal: Not performedNeuro: Neurological examination is grossly normal, no deficits notedDiagnostic tests:- Ear cytology (both ears): No evidence of infection (no bacteria or yeast seen).Treatment:- Elocon 0.5ml to be applied to both ears twice weekly ongoingPlan:- Apply Elocon to both ears once daily for 2-3 days. After 3 days, reduce Elocon application to twice weekly ongoing.- Continue Apoquel as prescribed- Continue Epi-Otic ear cleaner once weekly-monthly, applied on a different day to Elocon.- Owner to check expiry date of any Elocon they have at home. Elocon can be dispensed if a new bottle is required.- Consider use of an e-collar if scratching is excessive.Client Communication:Discussed the management of atopy. Explained that current medications like Apoquel manage the symptoms but do not cure the allergy. Discussed that allergy testing and desensitisation therapy is an option via specialist referral, but this is a significant financial commitment and requires long-term dedication. Can provide a script for Apoquel to allow owner to purchase online at a cheaper price if desired. The owner understands the plan and will monitor response to treatment.    Vital Signs