C09981005 / invoice 10000

Dispense more chloropt for ongoing treatment of ocular ulcer/inflammation

HISTORYPresenting for a French Bulldog, presented for follow-up evaluation of bilateral ocular disease, with the right eye previously noted to have a corneal scratch/ulceration and ongoing blepharospasm.Historical Conditions:- Previous corneal scratch/linear ulceration noted on right eye at last visit; fluorescein stain uptake confirmed on right eye at that time- History of otitis externa; treated in October with Apoquel (or similar) - ear issues tend to flare in spring/summer- Cutaneous mass previously identified right hip; previously tested (results confirmed benignCurrent Meds:- Antibiotic ophthalmic ointment (ongoing from previous visit)- Lubricating eye drops (ongoing)- Apoquel or similar - used during previous ear flare (October)- Metacam (meloxicam) oral liquid - client has remaining supply at home from previous prescription--EXAMMentation:Wt: 16 kgBCS:T: Not TakenHR:R:MM:Hydration:Behavioural: Patient was cooperative on the examination table; motivated by treatsEyes: Right eye - previously noted linear corneal scratch/ulceration now resolved; no fluorescein stain uptake; no active redness or inflammation noted. Left eye - conjunctival hyperemia present with mildly prominent blood vessels compared to right eye; small white opacity/spot noted on corneal surface; medial to centre, blepharospasm present (mild); fluorescein stain uptake equivocal - possible minimal uptake noted on left eye. Oral: Dentition noted to be in good condition (good teeth) per veterinarian.Integumentary: Cutaneous mass present right lateral hip); previously tested; assessed as likely benign ASSESSMENTRight corneal ulceration/scratch - Resolved. No fluorescein stain uptake; no residual inflammation.Left ocular disease - Active conjunctival hyperemia  mild blepharospasm, and small white corneal opacity. Equivocal fluorescein stain uptake on left eye raises concern for possible superficial corneal ulceration or erosion. Steroid use contraindicated at this time given risk of delaying healing and potential corneal melting if active ulceration present.Cutaneous mass - Previously tested; likely benign. Currently static but carries risk of future growth. Surgical excision with histopathology recommended given patient's relatively young age and good health status.---PLANNew Meds/Tx:- Continue antibiotic ophthalmic ointment to left eye - ongoing until ocular disease resolves- Continue lubricating ophthalmic drops - administer prior to ointment (allow interval between drops and ointment to prevent washout of ointment)- Meloxicam (Metacam) oral liquid - client has supply at home; dose to 16 kg mark on syringe; once daily for 4-5 days for pain management during active ocular flare- Note: topical corticosteroids are contraindicated at this time due to possible active corneal ulceration; to be reconsidered once fluorescein stain uptake is confirmed negative- If patient is rubbing excessively at eyes, consider use of an Elizabethan collar to prevent self-traumaAdditional Discussion:- Surgical excision of cutaneous mass recommended while patient is relatively young and healthy; plan to coordinate with dental procedure under the same anaesthetic if dental work is required- Excised mass to be submitted for histopathology- Long-term lubricating eye drops recommended ongoing even after resolution of current episode, given French Bulldog predisposition to KCS and recurrent corneal disease- Recheck appointment recommended in 7 days to reassess left eye and confirm resolution 

 HISTORY L eye squinting last few days.Apoquel 16mg daily dose for ongoing allergiesalso needs nails checked - esp dew clawsDermotic for ears - needs scriptElocon - were using 1-2 times per week in the earsO had noted has been rubbing face recently - unsure whether squinting started before or after that. otherwise has been wellEXAML eye - medial - pinpoint scar? no fluoro uptake. R eye - scarring medial cornea, but 0.3cm thin fluoro scratch centre of eyeskin - no skin fold dermatitis noted around facerest of skin looked OK todayASSESSMENT L eye - unlikely deep ulcer as no uptake at allR eye - thin line with mild uptake - active scratch?PLANchloroint TID both eyesmeloxicam for 5 days (O has at home) - if expired O can come in and purchase another bottleContinue apoquelcontinue dermotic for the complete course (script given today) - finds this more effective than PMPOWNER COMMUNICATION