C10016791 / invoice 10000

REASON: itchy earsHISTORY:- Ears itchy and smelly for several days- Owner using cleaning wipes for treatment- Persistent cough present as previous- No increased RR during sleep- current meds: Gaba +/- metacam, Hepatoadvance, Cardisure- has not had cytopoint in a while. EXAMINATION:BAR, MM pinkMusculoskeletal: ambulating normallyIntegument/Ears: otoscopic ear exa: erythematous, not thickened or ulcerated, mild wax debris present. Lump on tail as previus, scab present. Lymph Nodes: all <1cm, soft & symmetricalEyes: eyes open/comfortable, bilateral NSCytology: very few yeast on slide, no inflammatory cells, no bacteriaASSESSMENT:- Otitis externa - allergic. No evidence of infection. PLAN:- Treatment: Cytopoint 40mg injection administered. Ear cleaning every 2nd day recommended rather than daily for a week then back to once weekly. - Follow-up: Significant improvement expected within 24 hours. Next cardiac scan due with SASH. - Contingencies: Local anaesthetic procedure for tail lump removal possible if cardiologist approves - use torb to sedate and then local around the mass . Alternative referral for procedure under general anaesthesia if local approach unsuitable.    Vital Signs    Weight: 12.6;