C10032150 / invoice 10000

Subjective:Owner has noticed that Rory is scratching his ears, R ear worse than L ear. Also still chewing at feet - owner doing malaseb soaks every few days and seems to help but still waking up to itch at night. Also noticed that he has a very sensitive stomach - has diarrhoea off and on.Presented by: SamuelObjective:Current medication: nilDemeanour: QAREyes: good, small amount of hairloss around eyes - slightly pink?Ears: R ear reddened with brown ceruminous debris, L ear minimal redness, small amount of brown ceruminous debris TM intact bilaterally. Cytology: ++ yeast in R ear, + yeast in L ear.HR: 120bpmRR: 30bpmThoracic auscultation: NADOral exam: DGS 0, pink mm, crt <2sLymph nodes: NADAbdomen: NADReproductive: NADSkin: slightly pink interdigital skin on all 4 pawsGait/limbs: NADAssessment:Otitis externa, skin allergies, on and off diarrhoeaPlan:PMP 0.5ml BID in both ears for 7 days, recheck on day 91/ Discussed ears - option to start on elocon weekly after clearing up this ear infection, recheck ears in 9 days. Discussed possible allergic component.2/ Discussed skin - long discussion regarding medications ongoing such as apoquel or cytopoint (Samuel would like to talk to Ainsley about this and both will be present for next appointment).  Long discussion regarding diet trials and recommended considering RC anallergenic. Topical treatments may be less effective as itching all over.3/ Discussed diarrhoea - owner to check which flea/worming treatment that Rory is on, consider food trial - can be the anallergenic or novel protein (Prime 100). 

Subjective:Owner thinks he is going well on medication Owner thinks the ears are much better - less scratching or shaking Owner has been washing his paws with malaseb and pyohex - not licking them anymore He is otherwise going well, EDDU normally, no V+ or D+ No other concerns Objective:Skin: Very mild erythema interdigital both front paws, not moist Ears: Both ears look great, no erythema or discharge - both scope very clean Ear cytology Left ear: NAD Right ear: NADAssessment:1. Resolved bilateral OE 2. Very mild ongoing erythema front paws Plan:Owner to continue with soaks of paws another few treatments Owner to monitor ears Recheck if any ongoing issues 

Subjective:Owner reports that Rory has been scratching/shaking his ears since going to the groomer last week - also really chewing at his feet.Presented by: AinsleyObjective:Current medication: nilDemeanour: QAREars: reddened with yellow ceruminous debris bilaterally, TM intact. Cytology: L ear +++ yeast, + rods, R ear: +++ yeastSkin: reddened interdigital skin - cytology: +++ cocciAssessment:Otitis externa and bacterial pododermatitisPlan:Pred 7.5mg SID for 3 daysEasotic in both ears SID for 7 days, recheck on day 9Malaseb soaks 10 minutes twice weekly, followed by pyohex conditionerOtoflush after any contact with water/groomingDiscussed otitis externa and aetiology, may be allergy trigger. Will start on ear medications for now and recheck in 9 days, can recheck feet as well in 9 days.