C09995337 / invoice 10000

Presenting to recheck L corneal ulcer and also OE. O has been compliant with eye drops and doxy, ear meds stopped 1 week ago. scratching ears less but still did note him doing it occasionallyExam:Very wriggly and reactive/mouthy with ears. Needed nurse to holdeye looks great grossly, small dull uptake in area of ulcer, likely scarears normal grossly -  cytology L normal, R ear occasional rod still presentAssessment:likely scar remaining on L corneaOE still present in R earPlan:Continue ear drops in R ear until bottle finishedonce ear meds finished give a few days break then start weekly epiotic sisfinish off doxy tabs

See hx, was seen 1 week ago for R eye corneal ulcer and ear infectionDid well at home with medicationEDDU normalNo further concernsExam:Heart NADBAR!!Eyes: L eye NAD- fluoro negR eye: no conjunctivitis or scleritis, comfortable on exam, fluoro pos- pinpoint ulcer still present- shown JC -> appears to be unchanged from last week-- SEE PHOTO ATTACHEDEars: Both appear non inflammed but full of medication P: instilled alcaine into R eye and debrided ulcer with wet cotton tipdsp doxycontinue chlorsigcan stop ear medication- to rv this next weekRV 7 days

Had a groom on weekend, O noted when picked up R eye was sore and red. Has remained weepy and on/off red and squinty. O was told by groomer to rinse it in case it was shampoo. No effect. Also noted scratching ears at nightexam:BAR, a little anxiouseyes - L eye normal, R eye epiphora and slight blepharospasm. Fluorsceine stain +ve, pin point area on mid ventral corneaears - chronic thickening and scaling to pinnae. Ear canals swollen, cytology yeast + rods in L ear, R ear rods, yeast and cocci. Assessment:Corneal ulcer R eyebilat OEPatient wriggly and hard to medicate but O willing to give it a goPlan:tapering pred, given hand outchlorsig BID for 7 days (ideally recheck in 3-4 days but O cant get here any other day). Tried to demo in consult but got a bit nippyotomax BID to both ears, given 1st dose in consult. Warned ototoxicityrecheck eyes and ears in 7 days