C10016731 / invoice 10000

Reason: Sore Ears CCKMAppointment Notes: EDDU normal CCKMHistory: Head shaking and kicking at her ears. No previous ear infections, not itchy anywhere else. Has tried to wipe ears out. Does not routinely use ear cleaner. Does not swim. Last heat cycle roughly December. UTD preventionsExamination: BARDental grade 0BCS 5/9 Neuro: Appropriate mentation. Cranial nerves appear normal. Full exam not performed. Ears: Left has more debris and erythema of canal. Mild cobblestone appearance to right pinna with debris deep in canals and more pruritic. Otoscopic exam not performed. Eyes: Pupils symmetrical, no ocular discharge or pain. Full ocular exam not performed. Nose: No nasal discharge, NAD.Oral: No obvious masses.MM pink, moist, CRT <2. Skin: Normal hair coat, no lesions or hair loss. Feet are normal. LNs normal size, NAD. No heart murmur, sinus arrhythmiaNormal bronchovesicular sounds all lung quadrants. Abdominal palpation soft, no palpable masses/FB/organomegaly. MSK: Normal ambulation. Full exam not performed.Urogenital: No swelling or discharge, NAD. Laboratory: Left - Malassezia ++ and cocci +. Right malassezia +++Assessment: Bilateral otitis, but left is mixed infection. Discussed recurrent ear infections, particularly yeast can be allergic in origin so if we see this trend there are some prevention steps we can pursue. Treatment: Ears cleaned with PAW gentle ear cleaner.  Apex PMP 0.5ml BID into both ears for 10 days. Consent has been given by the client to proceed with this treatment  -  Yes Plan: Recheck cytology after treatment.    Vital Signs