C10020092 / invoice 10000

History:- Recent odour & itchiness affecting R ear. O has been applying Dermotic BID for the last 5dd - seems to be helping, but still looks sore. - There are also some lesion on his skin near his tailbase & medial thighs - he is licking these ++- O has been giving Pred for the last 3 days: 20mg PO SID.- Reports recurrent ear infections, particularly during spring/summer, with increased frequency depending on humidity. Typically experiences more than three infections per season.- Problems started seasonally from approximately two years of age.- Otherwise well, EDDU normal- UTD flea/tick tmts.Past Medical History:- Previous Cytopoint injection in May of last year; owner thinks that this was efficaceous.Physical Examination:- Demeanour: Bright and cooperative during examination.- Right ear: Marked erythema of the internal pinna and entrance to the vertical ear canal. No discharge visible on initial inspection. Moderate stenosis and discomfort on swabbing.- Left ear: No abnormalities detected.- Skin: Multifocal patches of scaling, dry, crusting seborrhoeic lesions distributed along the caudal dorsum, medial thighs, and caudal aspects of both hind limbs.- Paws NADInvestigations/Laboratory:- Right ear swab cytology: Occasional yeast organisms and white blood cells present.- Skin sticky tape preparation: Yeast organisms present (approximately 6-10 per high power field). No bacteria seen.Assessment & Plan:1. Right Otitis Externa (Yeast)- Impression: Improving but requires stronger anti-inflammatory ingredient.- Treatment planned: Commence Easotic ear drops, one pump into the right ear once daily for 7 days.- Clinician's recommendations, education and counselling for issue 1.: Advised to rub any excess medication from the ear canal entrance onto the inside of the earlobe/pinna to help with local irritation.2. Malassezia Dermatitis- Impression: Multifocal generalised yeast infection of the skin- Treatment planned:- Commence Terbinafine 500mgPO SID once daily until finished. Script provided.- Mediderm shampoo bathing once to twice weekly for 2-3 weeks. Focus on affected areas.- Tapering course of prednisolone (currently on 10mg once daily): continue once daily for 4 more days, then taper to every other day for 4 doses, then cease.- Restart fish oil supplements.- Clinician's recommendations, education and counselling for issue 2.: Discussed that bathing can be targeted to the affected areas (e.g., hindquarters) rather than a full body wash each time to improve compliance.3. Allergic Skin Disease- Investigations planned: Recheck consultation in 2-3 weeks.- Treatment planned: If skin and ear infections have resolved at recheck, will administer a Cytopoint injection to manage underlying allergies through summer.- Discussed potential for Elocon lotion as a maintenance therapy for ears once infection is resolved, to be applied every two weeks through spring/summer to prevent recurrence.Key Takeaways:- Administer Easotic ear drops to right ear once daily for 7 days.- Give Terbinafine tablets (two tablets) once daily until finished.- Continue Prednisolone as per tapering schedule: 10mg daily for 4 days, then every other day for 4 doses.- Bathe affected skin areas with Mediderm shampoo 1-2 times per week.- Schedule a recheck appointment in 2-3 weeks to assess response to treatment.- If infections are resolved at recheck, a Cytopoint allergy injection will be given & commence Elocon lotion for ears (maintenance).

Australis lepto booster

Subjective: - Conjunctivitis with eye discharge in right eye for 24 hours - Owner rinsed with saline last night which helped - Greeny discharge from right eye today - Small itchy lesion on belly - Previously seen for skin issues - Owner has used low dose prednisone orally for 3 days and applied cream - Skin lesion looking better - Otherwise wellPast Medical History: - Previous skin issuesObjective: - BAR, friendly - Good body condition - Right eye: mild yellowish discharge, mild conjunctival redness, no scleral reddening - Normal anterior chamber - Normal PLR and menace response - Left eye normal - Fluorescein stain of right eye negative - Small reddened half-moon shaped lesion on belly, approximately 4cm in diameter - Area clipped and cleaned with chlorhexidineAssessment: - Mild conjunctivitis likely from irritant - Skin lesion- localised dermatitisPlan: - Chloramphenicol eye drops twice daily for 5 days R eye - Monitor eyes, return if worsening - Continue low dose prednisolone for skin - Apply Bactroban ointment (previously dispensed) - Return if not improving or concerns