C09981150 / invoice 10000

going well ADUF all okExam:oral cav mm crt teeth okskin eyes Lns okears ok atm, R ear has some dry wax in it, nothing activeabdo oktrimmed nailschest ausc nad, hr = 124Plan fluox 10mg sid script

Preanaesthetic blood test: declinedPreanaesthetic cardiorespiratory exam: NADPremed: methadone 0.4 ml + medetomidine 0.08 ml IM. Good level of sedationInduction: PropofolMaintenance: Iso/O2IV Hartmanns during procedureAnaesthetic and unstable, profound bradycardia requiring atropine treatment and variable depth of anaesthesia. Requiring a combination of periods of no anaesthetic agent or additional propofol to maintain adequate depth. Therefore, modified dental procedure performed todayDental treatment: radiograph 208 - confirmed fracture extends into pulp cavity. No overt abscessation at this time. Extraction needed. Examination of the other teeth: slab fracture (superficial) 108 also but no other changes. Surgical extraction 208 - closed 4-0 monoq. Quick s/p all other teeth. Unable to perform full imaging. Unable to treat eyelid masses due to concerns re: anaesthesiaLeft ear exam: the material that was consistent with a mass was actually a blob of sebum attached to hair. Removed - TM intact. Small amount of hair at the level of the TM. No discharge. Attempted cytology but no real sample to take (so not charged). Novasone applied to the RIGHT ear only. Carprofen sc on recovery. Plan: carprofen SID : 25 mg each day, starting tomorrow morning with food, continue for 5 days. Gabapentin 200mg per oral q12, starting tonight and continuing for 5 daysDiscussed with male owner on the phone and explained limited treatment today. Happy with our decision making progress. Will monitor eye masses and teeth. Recheck in 7 days. SOFT food only until then. 

HISTORY: has been doing well since last seen a few months ago. Noticed shaking head and sore RIGHT ear. MEDICATIONS: noneEXAMINATIONEyes: tear overspill, small warty type lesion (<0.5 mm diameter) on the eyelid margin upper right eye and similar lesion lower left eyeEars: Brown (left ear) : no discharge, no discomfort, appears to have a fleshy mass growing from next to the TM. Unable to see the entire TM due to location, seems to have hair coming from the top. Right (spotty) ear : painful, itchy and red but no discharge, TM intact. Will not be able to safely perform cytologyMouth: slab fracture 208 (as noted before), mild gum reactionDental grade 1bLNs: NADCardiovascular: NADRespiratory: NADAbdo palp:  NADMSK: NADInteg: hair staining / pink skin under both eyes. otherwise NAdASSESSMENT:1. right ear : painful, unable to perform cytology today : starting prednisolone therapy indicated and perform cytology when presents for investigation of the left ear2. left ear : suspected mass adPLAN: book for GA with rads, possible removal of affected tooth and investigate lesion in the ear. Warned owner that we may need to send for specialist imaging if we are concerned the lesion broaches the TM. To closely examine both ears when under GA.