C10026577 / invoice 10000

Reason: Recheck earsHistory:Been on 7 days PMP bilaterally for yeast OEItching a lot less but still head shaking a bitOtherwise wellPhysical Exam:BARmm p/m crt <2sMild brown material within right ear canal, very little from leftCytology:- R: Mod yeast 2+- L: Mild yeast 1+Assessment:Responsive but persistant OEPlan:Continue PMP for another 7 days. Recheck to ensureall resolved

History:- Presented for recurrent ear issues. Owner noticed red ears after cutting the coat. One ear has some build-up of brown debis. Owner notes hair is long. History of ear infections from time to time, approximately one per year for the last couple of years.- Shaking head. Very itchy. Rest of skin is fine- EDUD normally, no V/D/C/S- Not on any current medications.Physical Examination:- Demeanour: Bright and responsive.- Vital signs: HR 140bpm, no murmur. RR panting. Temp not taken.- Mucous membranes pink and moist, CRT <2s.- Abdomen: Soft and comfortable on palpation.- Integument: Full coat, healthy skin. Both ear pinnae and canals are moderately erythematous. No obvious aural discharge on swab taken. Strong pedal reflex when swab taken.Investigations/Laboratory:- Ear Cytology (bilateral): Moderate - significant yeast present bilaterally.Assessment & Plan:1. Bilateral Otitis Externa - Yeast otitis.- Clinician's recommendations, education and counselling for issue 1.: Discussed that ear infections are not uncommon in this type of dog, but if they become more frequent than once a year, preventative options are available. This includes a weekly ear product containing a steroid and an agent to reduce yeast/bacterial overgrowth, which helps manage local inflammation and prevent flare-ups. For now, treating the current infection is the priority. A recheck in one week is recommended to ensure the infection has resolved completely before stopping treatment.Plan:- Dermotic. Administer 0.5ml into each ear twice daily for seven days. Owner instructed to fill the ear canal and massage the base of the ear. No pre-cleaning is required as the canals are clear enough for the medication to penetrate.- Prednisolone tablets, tapering course for inflammation. Will cause polydipsia and polyuria, and potentially polyphagia. Dosing schedule: one tablet twice daily for three days, then one tablet once daily for three days, then one tablet every second day until finished. Stressed the importance of not stopping the medication abruptly.- Recheck in 7 days to ensure infection fully cleared- If ear infections become more frequent, consider discussing preventative treatment options.

Reason: sore earHistory: EDFU okNO V+ and D+noticed sore ear yesterdayExamine: Vitals WNLdischarge and inflamation L earR ear NADcytology cocci and yeast +++T=Nall other NSFAssessment: OE L earPlan: Dermotic BID 10 days