C10029397 / invoice 10000

Reason: Recheck EarAppointment Notes: ------- Sms reply: YO will arrive in 5 minutes CCEHHistory: Millie is presenting today for reassessment of her ears. 10 days ago, cytology revealed bacilli bilaterally, worse on the left ear. She has been administered easotic and dermotic BID. She had a swim in a dam about 9 days ago. Millie is no longer bothered by her ears, she is not shaking her head or scratching her earsExamination: L ear- black waxy material, mild inflammation of the canals, tympanic membrane in tactR ear- black waxy material, mild inflammation of the canals. Tympanic membrane in tact. On swab, there was a blade of grass. No foreign body was identified on examinationLaboratory: Ear cyclolyL ear- Bacilli scantR ear: Bacilli with intracellular involvement. Improved compared to last timeChecked all paws- found two grass seeds in webbing of paws of thoracic limbs. Assessment: Improved but unresolved bilateral bacterial otitis externaTreatment: Continue to administer easotic and dermotic BID for a further 5 days. Administered easotic in consult. Plan:Recheck ears in 5 daysDiscussed at length the causes of allergic dermatitis. Suspect Marley and Millie may have atopy and it may not be food related. If we are continuing to have reoccurring ear infections, recommend consulting with dermatologist for allergy testing. Discussed medications that act as an immunosuppressor which may be an option.    Vital Signs