C10027692 / invoice 10000

Reason: Ear infectionHistory:  Ear infection. Both ears. L worse than R. Licking feet. Chornic skin disease managed with cytopoint. Otherwise BAR, EDDU normally with no signs of CSVD. UTD with vaccination and flea/worm/heartworm control (Nexgard spectra). Current problems - Ear infectionPre-existing conditions - Chronic skin diseaseCurrent medication - Cytopoint monnthlyExamination: L worse than RLeft and right ear: Moderate erythema of the external ear canal, mild yellowish-brown discharge (wax-like), signs of discomfort upon palpation. No swelling or severe pain notedLaboratory: L and R ear - yeast +++ and bloodAssessment: Bilateral otitis externaDiscussed with owner:Predisposing causes - long ears, humid environment, swimmingPrimary causes - foreign bodies (grass seeds), parasites (ear mites), hypersensitivity (allergy), endocrine disorders etc. Secondary causes - bacteria and yeast Discussed with owner most likely allergy and going to be recurrent issue. Discussed chronic skin disease. No cure but can manage clinical signs. Discussed management - 1. Antihistamines - cheap, minimal side effects but not very effective (30%); 2. Prednisolone - cheap, effective but side effects (drink and urinate excessively, eat excessively and long term effects on liver/kidney); 3. Apoquel - effective, minimal side effects but expensive); 4. Cytopoint injection - effective, minimal side effects; 5. Allergy vaccine (referral) - effective, minimal side effects but expensive.Owner agreed to the treatment plan.Treatment: Consent has been given by the client to proceed with this treatment  -  YesCleaned both earsDermotic in both earsPlan: Apoquel 5.4mg - 1 twice a day for 2 weeksDermotic 1ml twice a day for 7 daysFollow-up in 1 week for reassessment of ear infection.Return sooner if symptoms worsen or fail to improve.    Vital Signs    Weight: 12.7;