C09988819 / invoice 10000

recheck eyes and earseyes -STT not done. Lots of obvious green gunk. Said to increase the tacrolimus to tid. They wanted tricin as well as they said the gunk goes away with the tricin.Wrote a script for the tacrolimus. They are going away for 2 weeks and wanted the paharmcy to deliver the tacrolimus to have it there by 20th.Both ears still infected, topigen dispensedowners going away for 2 weeks in november, will be with a pet sitter

Hx:tricin works while applying but once stops then comes back within a couple of dayslumps have been better since expressed but has a new one back left hipclean eyes daily, did this morning but noticed more back alreadyears ok at the momentExam:both eyes green dischargefluoresceine neg after flushing and close checkingleft eye 3rd eyelid has a small black bobbly bit medially (previous injury vs growth)right eye neovascularisation dorsally over 1/3 of the corneaboth eyes chronic scleral injectionclipped inner pinna as some gunk in the hair, owners feel this is not a current issue but will monitor closelyleft caudal bottom adjacent to tail base small 1cm soft fluidy lump - clear fluid gainedFNA - clear yellowy fluid, a few RBC otherwise acellularAssessment:previously dx dry eyeposs ear infection starting? or at risklump on bottom - likely cysticPlan:ears - otoflush at home and recheck when in for eye recheckorder tacrolimus and start treatmentmonitor lump near bottom - may rupture in futurerevisit 3 weeks and recheck ears and STT eyes

 Dispensed today, but Come in to discuss alternative, more appropriate treatment options if referral isn't an option. - SF (have spoken to MF) Spoke to male owner.  He is not keen on referral as too expensive.  He will bring Rowan in for a consult at some stage to discuss.  LEworking well