C10017343 / invoice 10000

Reason: RecheckAppointment Notes: Overdue reminders  ------- Sms reply: YesPATIENT:Chewy2 yearsMaleWeight:History:Chewy is a 2 year old male who was presented today for recheck to monitor bilateral otitis. Owner reports ears have been cleaned for 4 weeks. Chewy tolerates ear cleaning well.Examination:Vitals:Physical Exam:    - EENT: Right ear improved, less rods present, appears settled. Left ear worse since last week, similar rod count to previous visit. Wax present in both ears. Right ear less bacteria than left. Neutrophils/white cells present indicating inflammation has settled.Diagnostic Results: Cytology - right ear improved with less rods; left ear similar rod count to last week. Bacteria present in both ears, left ear has more bacteria than right.ASSESSMENT:Bilateral otitis - right ear improved, left ear persistentPLAN:Diagnostic/Treatment Plan: Ear cleaning performed today. Antibiotic gel applied to both ears. Recheck in 1 week. If no significant improvement, will need to reconsider treatment strategy.Recommendations: Continue ear cleaning at home with warm water, no solution required.    Vital Signs    

Reason: C/u + VaccinationAppointment Notes: Overdue reminders  ------- Sms reply: YesPATIENT:ChewieBrown maleWeight:Reason: Recheck ears, vaccination dueHistory:Chewie is a brown male dog presented today for recheck to monitor ear condition. Owner reports still gunk in ears, cleaning every night, decreased each time but still present. One episode of vomiting. No diarrhoea. No head shaking. Not bothered by ears. No scratching except during cleaning. After cleaning, flaps ears and wipes face, then bites feet.Current medications: Antibiotics (finish course), P and P ear medicationExamination:Vitals:    - Temperature: N    - Heart Rate:N    - Respiratory Rate:N    - Weight: NPhysical Exam:Cs Ok legs okabd ok    - EENT: Right ear - significant debris, moist. Left ear - less debris than right, still waxy, moist.Diagnostic Results: Cytology both ears - bacteria significantly reduced compared to previous. Left ear slightly more bacteria than right. Right ear took longer to find bacteria on microscopy. rods found left ear neutrophilsASSESSMENT:Chronic otitis with reduced bacterial load but persistent moisture and debrisCurrent treatment not effective enoughPLAN:vacc C5Diagnostic/Treatment Plan: Clean ears today. Apply clotrimazole gel to dry out ears. Continue P and P but cease cleaning. Finish antibiotics. No bathing at this time. Recheck in one week.Recommendations: If no improvement, may trial compounded gel (enrofloxacin, dexamethasone, mometasone) or consider referral to dermatology specialist.    Vital Signs    

Reason: Phone (voicemail)CT:O wanted to book check up and also Chewies Vaccination for nex weekO also wanted to confirm instructions on Pred Label:1 tablet a day for 3 days, then 1/2 a tablet once a day for 3 days then 1/2 a tablet every second day    Vital Signs