C09987312 / invoice 10000

Reason: Ear - Yellow Discharge & Head Tilt NGAppointment Notes: Overdue remindersHistory:Noticed scratching the right ear a lot recently, will shake the head, has had this before, last one was bad but been 2 years. O cleans them regularly, every week. otherwise well, EDDU normal.Examine: BARR Ear: hyperaemic pinna, hyperplastic ear canal, stenotic, yellow greasy discharge, sensitive to touch.L ear: NSFHR 100PantingAbdominal: tenseNo murmur or arrhythmiaEar cytology: yeast +++, Rods ++++Assessment: Otitis externa - chronic,  Malassezia and rodsPlan: At this stage, it's not curable any moreManage as chronic caseBova gel 1ml Repeat in 7 daysReview in 2 weeksIf keeps reoccuring, last resort might have to consider ear canal ablationMacrolone SID then EOD PO    Vital Signs    Weight: 37.2;       

Reason: Torn NailAppointment Notes: Overdue remindersRF 5th digit on angle sidewaysRenmoved conscious. No bleeding    Vital Signs    Weight: 36;       

Reason: Lump Check Appointment Notes: Overdue remindersFound lump the other day, noticing intermittent limp - unsure whether this leg. Do usually see him limp when it gets colder so unsure related.  Examine: BAR BCS 5/9MM pink CRT 2sR shoulder has a firm lump just above elbow. Local LN feel OK.Aspirate - fat cells and occassional RBC. Likely lipoma but monitor closely dt position, if becomes significantly larger would recc removal dt potential for impairment on mobility.    Vital Signs    Weight: 35;