C10022938 / invoice 10000

Reason: Re Check Ears And EyesAppointment Notes: Overdue reminders  ------- Sms reply: YHISTORY:  Recheck consultation for severe bilateral OE - suspected possible intra-cranial abscess/infected mass. EXAMINATION:Demeanour: BAR happier than beforeIntegument/Ears: Cytology samples taken from both ears. The left ear shows significant improvement. The right ear shows slight improvement, with resolving ulceration and less haemorrhage, but significant purulent discharge remains. Otoscopy AD: Can see either ear medication or pus in vertical ear canal AS: Can see less Eyes: Less stringy mucopurulent discharge DIAGNOSTICS:AS: some odd rods or maybe melanin granules located close to squamous epithelial cells. Still a lot of stringy proteinaceous debris?AD: A lot of segemented neutrophils still. At least 20 per HPF ASSESSMENT: Recheck for severe bilateral otitis. The less affected left ear is responding well to treatment. The severely affected right ear has shown only slight improvement after two days of medication. Significant purulent discharge persists. An underlying head mass remains a differential, and further diagnostics such as a CT scan may be required if there is no significant improvement after completing the course of medication. TREATMENT:  Dispensed one additional bottle of ear medication. Continue applying to both ears once daily. PLAN:Continue current ear medication once daily in both ears until the recheck appointment.Recheck consultation booked at North Lakes clinic for 07:40 on Friday, 20/03/2026.If no significant improvement is noted in the right ear at recheck, a head CT scan is the recommended next step to investigate for an underlying mass. CLIENT COMMUNICATION:Discussed examination and cytology findings. The left ear is improving well, but the right ear shows only minimal improvement. Advised to complete the course of ear medication and continue treatment until the recheck appointment on 20/03/2026. The recheck is booked at the North Lakes clinic.Discussed the possibility of an underlying growth in the head if the right ear does not respond to treatment. A head CT scan was recommended as the next diagnostic step in that event. Provided an estimated cost for a CT scan starting from $1800. An official quote will be sourced from the specialist centre and emailed to the owner to facilitate a pre-approval claim with their pet insurance.    Vital Signs