C10028032 / invoice 10000

Treatment: Consent has been given by the client to proceed with this treatment  -  Yes10 mcg/kg medetomidine IM to faciliate IVC then 0.2 ml propofol IV. Reversed half vol atipam IM Full otic exam done, both TMs intact, canals normal, no inflammationCytology scant poorly staining yeast, likely not active infectionPlan:Disc findings with O and may still have other root cause such as atopy however at this stage monitor and have ruled out FB, TM issues, etc    Vital Signs    Weight: 14.7;       

Reason: 14.5kg Ears Appointment Notes: ------- Sms reply: YReason: History: - First seen 16/2 for 2nd vaccination, however it was deferred due to diagnosis of ear infection and intermittent soft stools- Seen last week for follow up, P had haematochaezia the day prior to the appointment but has been improving. Ear infection had not resolved and commenced easotic. - Completed 5 day course of Easotic and revisit today for follow up - Vomited on Monday, did not eat breakfast. Gave boiled chicken, slowly introduced normal food back. - Had bad diarrhoea yesterday, melted soft serve. Today has done two good solid poos, trailing soft.  - Currently eating prime 100 puppy chicken brown rice, RC puppy biscuits. Still BAR and has a good appetite now - O bringing Rupert to Adelaide next week - PP UTD - NGS Examination:BAR, euhydratedMM Pink CRT <2 Ear exam not toleratedLaboratory: Ear cytolMalassezia + and cocci + bilaterallyAssessment: 1. OE not resolving2. Waxing and waning v+ and d+ (Ddx - food sensitivity/allergy vs infection vs dietary indiscretion vs other) Treatment: Consent has been given by the client to proceed with this treatment  -  YesC4 Vanguard SQKC BB PO Plan:- C5 vaccination administered today.- Booked for sedated ear examination and clean on 12/03/2026.- Discussed prescription diet for gastrointestinal sensitivity. Recommended Hills Prescription Diet Gastrointestinal Biome or I/D.- Owner to not recommence easotic medication tonight. Will counsel other vet tomorrow for second opinion. Client communication:- Discussed the common and frustrating nature of ear infections in puppies, especially long-eared breeds. Explained that multiple rounds of treatment for OE is not uncommon- Provided an estimate for the sedated ear flush: $665 - $798. Explained to O benefit of performing ear flush is to be able to thoroughly examine the ear for any TM rupture, structural/anatomical changes that can alter ear medication effectiveness, ability to clean ears, as well as instill ear medications. - O would like to vaccinate Rupert today as he is 20wks old and overdue for second puppy vaccine. O also concerned he may be not be protected when he is in Adelaide next week. - Discussed risks of vaccination while experiencing mild gastrointestinal signs and ongoing OE due to concerns of increasing a risk for a vaccine reaction, including difficulty differentiating a vaccine reaction from ongoing illness if Rupert were to have v+ or d+. Explained to O if Rupert is exhibiting signs of anaphylaxis (v+, d+, collapse, dyspnoea) that they may need to go to an emergency centre. Owner consented to proceed with vaccination due to travel plans and exposure to other dogs.- Pre-procedure instructions for 12/03/2026 provided: admit at 8:30 am, no food after 8:00 pm the night before, water is permitted.- Discussed post-sedation care: may be drowsy for a couple of days with altered appetite and toileting habits. Further aftercare instructions will be provided post-procedure.- Advised on post-procedure follow-up. Recommended recheck 3 days post-op to assess anaesthetic recovery and 1 week post-op for ear check. Client will be in Adelaide and may see a vet there. Advised that clinic histories are not shared interstate and will need to be requested.--- 06/03/2026 09:49:06 NJE:Called O, no answer and left VM:Hi Sarah, this is Dr Nynne from Greencross Preston who saw Rupert yesterday. How is he doing after his vaccine? I had a chat to my colleagues and they recommend still continuing the ear medication for another 5 days until the ear flush appointment. Please give us a call back if you have any questions or concerns--- 06/03/2026 11:25:47 AM SUC:Examinations - Resolved - recall done by vet - CTS--- 06/03/2026 15:11:54 NSU:LVM as per NJ    Vital Signs    Weight: 14.5;       BodyScore: 5;       

Reason: 12.5kg Ear / Infection / Follow UpAppointment Notes: Booked Online: 16/02/2026 20:08:11 PMBooking Type: Skin, Ears, Eyes or LumpsBooking Notes: Follow up from ear infection Owner Name: Sarah RoxbyOwner Email: sroxby@hotmail.comOwner Mobile Number: 0413173420Pet Name: RupertPet Species: DogWeb BookingClient name: RoxbyContact number: 0413173420Email address: sroxby@hotmail.comPatient name: Rupert  ------- Sms reply: YHistory:- Recheck of ear infection (seen 1 week ago).- Reports diarrhoea, which is now improving. Observed a small amount of frank red blood in the stool on Sunday, which has not recurred. Stools are now firming but can have a soft consistency at the end of the motion.- EDUD otherwise normal.- No other concerns from owner.Diet: Royal Canin Maxi puppy and Prime 100. Recently given a yoghurt lick mat, which has now been discontinued since diarrhoea- ears are improving, but O still can smell them Vaccination: Last vaccination >6 weeks ago. Now overdue.PP: NexGard Spectra. UTD.Pre-existing conditions: Possible deafness in one ear.Examination:DEMEANOUR: BAR - focused examination as getting mouth-y with ear/general examinationMM: pinkEyes/ears/nose: Nose noted to be dry by owner. Moderate waxy discharge present at the entrance to both ear canals. Unable to perform ear examination today dt temperamentMSK: ambulatory X4BCS: 12.5kg, 5/9Laboratory:Ear cytology (bilateral): Yeast organisms present. Fewer bacteria seen compared to previous cytology. No pus or blood noted.Assessment:1. Otitis externa (bilateral, yeast and bacteria) - persistent. - ddx. Compounded med not suitable for yeast2. Diarrhoea - resolving - ddx. dietary indiscretion (dairy), stress colitis, parasitic. Vs. Other Client communication:Discussed the persistent nature of the ear infection. Explained that while the new medication (easotic) is considered safe for use in cases of potential eardrum rupture, no medication is officially licensed for middle ear use. Advised on the small risk of ototoxicity and to monitor for signs such as head tilt or facial paralysis, and to stop medication and contact the clinic if these occur. Explained the importance of correct ear medication administration technique, demonstrating how to straighten the ear canal and massage the base of the ear. Discussed management of diarrhoea, advising a consistent diet, reduction of treats, and use of a probiotic. Advised that due to the ongoing ear infection, vaccination will be postponed. Plan for a recheck in 7-10 days. Discussed that if there is no improvement, a sedated ear flush may be required. Offered gabapentin for anti-anxiety/sedation to assist with medicating, but owner declined for now. Advised owner on transferring microchip registration.Treatment:Consent has been given by the client to proceed with this treatment - YESAdministered first dose of easotic ear drops in-clinic (1 pump per ear) - apply one pump into each ear once daily for 5 days.Prescribed Metacam Oral Suspension: give 12.5kg dose orally once daily with food for 5 days.Dispensed fortiflora probiotic powder.Plan:- Maintain a strict, consistent diet with no treats or dietary changes.- Do not clean ears or allow water to enter the ear canals for 14 days.- Recheck consultation in 7-10 days to assess progress. Postpone vaccination until ears have resolved.- Advised owners they can book nurse appointments for assistance with medication administration if required.--- 24/02/2026 09:34:32 AM CG4:Examinations - Resolved - General follow up message sent KL    Vital Signs    Weight: 12.5;