C10028309 / invoice 10000

Reason: Ear Flush--- 13/03/2026 08:01:11 rw:O realised she had been giving sonny 0.1ml of the ear drops ---- 13/03/2026 11:22:33 GR:LS gave 0.35 butorph/0.25 medetom IM total Reversed part sedation with 0.2 ml antisedan IM at 1 pm IV canula placed Alfaxane to effect Intubated 9 mm cuffed ET Ear exam -- L ear discharge and inflamm ++ ( worse than R ear ) , can visualise tympanic menbrane - just looks thickened Cleaned with saline , dried well Clipped hair around pinna R  ear discharge and inflamm ++ ( worse than L  ear ) , can visualise tympanic menbrane - just looks thickened Cleaned with saline , dried well Clipped hair around pinna Check with o has easotic at home or needs more Will check with BB about the enro/pred ear mix and disp when have that info Meds - TGH with pred 20 mg 1 daily x 4-6 weeks ( supply 30 ) Easotic - 1 pump per ear SID Triz/enro/dex mix 1 ml BID1 ml IV daizepam given as hyper aesthetic on recovery Needed 10 mins 2 flow by    Vital Signs    

SubjectivSonny has been experiencing anxiety and has had issues with his ears. Previous concern about a sore back, now resolved. Mention of dermatitis on his lips.Cuurent meds- easotic, gaba, clavO says back betterObjective:T , BW kg, BCS /9HR: , MM pink, moist, CRT < 2secEENT - Ears previously treated with medications and drops, ongoing issues notedDENT - NADH/L - Normal rhythm, no murmurs. Pulses strong & synchronous. Normal RR & effort.ABDO - Soft, non-painful, no palpable massesUG - WNLMSK - NADNEURO - Gait & mentation normalOther issues - NoneAssessment:Anxiety - diagnosedEar issues - ongoing treatment- today ha songoing purulent d/c both sides- rpt in vueDermatitis on lips - notedPlan:Continue with ear medications and drops as previously prescribed.Administer vaccinations as required for boarding and daycare requirements.- will do lepto & SR12 in april.Donna has to go away for medical tx for 6 weeks & currently has sonny booked into hanrob but hasn't clarified whether they will medicate him.Adv likely two options:1. Brd at hanrob with set & forgot tx plan to manage his ears as far as practicla whilst she's away2. Brd here & tx more aggressively- GA/flush/poss CT, rpt C&S, order compounded combo gelLaboratory:  ears show persistence of mixed infection.Jwg discussed with BB- rx sedate/flush ears then provide 4-6 weeks for dex/enro/triz flush (triz edta+5ml enro+2ml dex)- apply 1ml BID, + easotic sid + 4-6weeks fo oral pred 1mg/kg/dayPrepared est for flush--- 09/03/2026 18:55:02 JAM:Hi Donna, I tried calling to suggest that we sedate Sonny tomorrow to flush his ears out. If you agree then give us a call first thing to arrange. Thanks, Jamie--- 10/03/2026 16:11:56 CLA:Tried calling, no answer so LAVM. Emailed options with estimate for flush attached.--- 10/03/2026 16:17:27 LOC: ap O called back, booked in for friday for ear flush, given estimate    Vital Signs    Weight: 18.4;       

Reason: EarsHistory:Presenting for: Sonny Williams presented for follow-up of bilateral ear infections. Owner has been away for 6 weeks and reports difficulty administering oral Gabapentin medication, though ear drops have been manageable.Historical Conditions: Back pain previously treated with Gabapentin. Dermatitis with topical treatments. High anxiety levels noted by behavioural specialist consultation.Current Meds: Ear drops (administered this morning), Gabapentin (difficult to administer), topical cream for dermatitis, cleaning solution for earsLifestyle Risk Factors: Lives with owner who has two adult daughters at university. Recently separated from owner for 6 weeks. Referred to behavioural specialist for anxiety management.Other: Owner reports dog is very anxious and protective. Behavioural specialist noted this spaniel's anxiety levels are unusually high compared to other spaniels.Ear swabs 1 month ago indicated 2x bacteria isolated from mixed swab of both ears (?) with mixed sensitivity profiles. - pseudomonas sensitive to gentamicin, marbo, polymixin B, intermediate to enro, resistant to all else - strep canis sensitive to amoxyclav, cephalexin, florfenicol, penicillin, intermediate to marbo /enro.Examination:Mentation: BAR - very anxious but tolerant of examWt: 18.4kgBCS: 5/9T: not takenHR: 112, regularR: panting/vocalisingMM: pink and moistHydration: euhydratedBehavioural: Highly anxious during examination. Required significant calming and reassurance throughout procedure. Dog was distressed during ear examination and swab collection.Eyes: NADEars: Bilateral ear infection present with creamy brown gunk and discharge visible. Ears appear mildly inflamed - slightly pink but not severely red or swollen. Infection appears improved compared to previous examination but still present.Nose: NADThroat: NADOral: mild dental plaqueCardiovascular: NADRespiratory: NADAbdominal: NADLymph Nodes: NADIntegumentary: Dermatitis appears improved with current treatment. Some scratching noted this morning but less concerning than ear issues.Neurologic: NADMusculoskeletal: NAD - briefUrogenital: NADRectal: not doneDiagnostics: InVUe: bilateral cocci +++, rods +++, yeast +++Manual prep: bilateral cocci +++ rods +++ no yeastAssessment:Bilateral otitis externa - Persistent infection with two different bacterial isolates. Previous culture showed intermediate sensitivity to current treatment, explaining poor response. Requires targeted therapy for each bacterial isolate.Plan:Vaccinations: Vaccinations due but postponed until ear infection resolved. Will administer at recheck appointment when infection cleared.New Meds/Tx: - Oral antibiotic (sensitive to isolate 2) - one tablet BID for 2 weeks with food- Topical ear medication Easotic - one pump SID for 5 days to both ears, starting tonight. Prime pump before first use, administer as deep in ear canal as possible- Gabapentin - additional supply provided in full box for ongoing anxiety managementAdditional Discussion:- Infection involves two different bacteria requiring separate targeted treatments- New treatment plan based on culture sensitivity results rather than continuing ineffective intermediate-sensitivity medication- Recheck appointment scheduled in one week to assess treatment responseClient Comms:- Explained that current medication showing only intermediate sensitivity and infection persisting despite treatment- Discussed need for dual antibiotic approach targeting specific bacterial isolates- Advised infection is external only and should not affect hearing- Recheck in one week, vaccinations to be completed once ears clear    Vital Signs