C10028711 / invoice 10000

Reason: 2nd Lepto, Cytopoint And Check EarsHx: Ear infection - left, ongoing for 7 daysNo meds currentlyItchy paws this week - o thinks minimal erythema. Forelimbs usually more affectedPEBAR in consL ear - stenotic canal, signfiicant erythema, brown discahrgfe. Unable to see TMR ear - no stenosis, very small maount of brown discahrge, no singificant erythema. TM intact and visibleHeart and lung ausc NADAbdo palp comfortablePaws look ok currentlyVac with L2 and given 40mg cytopointCleaned ears in consAdvised consider preds in a few days (declined today) and start dermoticRecheck ears in 7 daysPred 20mg instructions ***o can call if decides wants these in the next 3-4 days***Give 1 tablet ONCE daily for 3 daysthen HALF a tab ONCE daily for 3 daysthen HALF a tab EVERY OTHER DAY until doneStart Tuesday 10/03Verified: NoHistory:Presenting for: Mojo presented for second part of vaccination, Cytopoint injection, and ear infection affecting primarily the right earHistorical Conditions: History: of chronic atopic dermatitis with recurrent ear infections, usually affecting the right ear but occasionally both earsSkin: Paws have been pruritic recently, owner reports dog having a scratch when comfortable, ventral areas typically most affectedCurrent Meds: No daily medications currentlyExamination:Behavioural: Cooperative for examination and injectionsEars: Right ear canal inflamed with malodorous discharge, left ear canal open and less inflamed. Otoscopic examination performedIntegumentary: Skin appears good on surface examination, paws showing early signs of pruritisDiagnostics: Ear cytology from both ears - Malassezia and bacteria present bilaterally, more significant in left ear than expected, but more in right ear as anticipatedAssessment:Otitis externa - Mixed Malassezia and bacterial infection present bilaterally based on ear cytology, more severe in right ear as expectedAtopic dermatitis - Early signs of seasonal flare with pedal pruritis, likely contributing to ear inflammationPlan:Vaccinations:- Second vaccination administered subcutaneouslyMedications/Treatments:- Cytopoint injection administered today for allergic dermatitis and pruritis- Ear cleaning performed in clinic- Topical ear medication (previously used successfully) prescribed for both ears BID for one week, 0.4mL per ear using provided syringes or dropper- Short course of tapering steroids offered (one tablet daily for 3 days, then half tablet daily for 3 days, then half tablet every other day) to open ear canals and improve medication penetration - client declined, preferring to try topical treatment alone first- Steroids can be dispensed later if needed without additional consultationAdditional Discussion:- Humid weather contributing to current ear infection- Ear medication should be started 30 minutes after morning cleaning- Recheck appointment recommended in approximately one week to assess treatment response- If topical treatment insufficient, oral steroids remain available optionClient Comms:- Wait until Tuesday to start any oral steroids if needed due to recent vaccination- Contact clinic if ear condition worsens or doesn't improve with current treatment Plan:- Steroids available for pickup without appointment if treatment response inadequate    Vital Signs