C10019682 / invoice 20000

Went to see an osteopath for dogs who also found pain on his neck. Did some realignment for him and seems to be doing well. Ears not bothering Panda. Overall seems betterExam:D: BAR  TPR WNLEars: some brown discharge in R ear. L clean. MSK: normal gait. No neck/spinal pain.Neuro; normal mentation. Normal CPs. CVS: normal rate and rhythmEar cytol: scant yeast in R ear. None in LAssessment:Neck pain resolvedOE managedPlan:Continue cortavance/austrazole twice weekly maintenance ongoing.Free bravecto as per loyalty program.  Md    Vital Signs    

Appointment Notes: Overdue remindersJust NQR. Unsettled. Difficult to collect Hx as there is a bit of a language barrier.Doesn't like ear spray.Eddu normally. No v/d/coughing/sneezing.Is breathing rapidly at times. Seems painful around ears/headExam: nervous - will biteD: BAR   BCS 5/9HR 104  RR 44   T 38.8OMM pink and moist   CRT <2secOral: C1/G0Ears: (examined OTB muzzled): L ear no inflammation or discharge. R ear mild erythema of horizontal ear canal with some brown discharge in distal canal.  Both tms intactCVS: normal rate and rhythm, no audible murmurResp: normal BVs bilaterallyLNs: palpate normallyAbdo: comfortable on palpationMSK: no lameness. Repeatable neck pain on dorsal manipulation, comfortable on palpation of cervical spine. No thoracic/back pain. Rest of exam unremarkableNeuro: normal mentation. Normal CN function. No ataxia/weaknessEar cytol:L: no organismsR: scant yeast Assessment:Neck pain most likely causing vague symptoms at home. Ongoing mild malassezia population in R ear. Treatment;Metacam 0.2mg/kg scPlan:Strict rest with no ball play or walks for 2 weeks. Metacam sid 7d starting tomorrow night.O to bring in cortavance form home for us to apply 2mL austrazole into cortavance bottle and agitate. Place label as printed - apply 0.2mL of solution into both ears once weekly ongoing. Recheck in 2 weeks with FA or sooner if worsens neurologically    Vital Signs