C09999915 / invoice 10000

HISTORY
visit for red R eye and reoccurrence of SCC at R inguinal area 
- past 1wk: had red eyes with ocular discharge - Hx of conjunctivitis (suspecting allergy-related) thus O was cleaning daily 
-> 2d ago: noticed "red dot in her eye" and last night noticed scratch on just lateral to the R eye lateral canthus (suspecting due to self-trauma of scratching eyes) 
- discharge still noticing and generalised redness (periocular skin), no swelling 
- EDDU normal, doing well otherwise 

- Hx of lumpectomy for SCC at R inguinal area 
-> few masses started to re-appear again, O suspecting irritation/painful as she is walking funny with her R-HL (also known to have OA) 

Current Medications= imiquimod cream 5% on masses 
N = No Abnormalities Detected 
Behaviour = known to be snappy, O happy with muzzle and requested to take her behind Tx room for exam

Examination:  
Gen App: BAR 
Pain: >2/5 (very reluctant to open R eye + red raw masses at inguinal area) 
MM / CRT: muzzled 
Eyes = R eye: centre of the globe - ~5mm diameter red spot (appears haemorrhagic) with cloudy circumference, circumference = stain positive, mid-cornea = stain negative (concerned of deep ulcer...) 
-> failed to get IOP (difficulty keeping her eye opened despite alcaine drops) 
-> got very agitated with eye exam, stopped attempting IOP today 
Skin = R inguinal area: 2-3 markedly erythematous raw masses, no active bleeding or discharge but slightly reactive to touch and moist (likely mildly oozing)  
M/S = HL stiffness with R-HL wobbly gait (suspecting her avoiding contact with the inflamed masses) 
Neuro = n 

ASSESSMENT: 
- R eye: top DDx - deep ulcer with ruptured cornea (suspecting secondary to self-trauma), doesn't appear to be true neoplasia, open 
- inguinal masses: highly concerned of SCC reoccurrence with secondary infection

O agreed to see Paws at Prospect for second opinion and Tx/Mx for R eye 
-> prioritising eye condition, meanwhile O agreed to give AB course to reduce inflammation and suspect secondary infection of the masses 
-> once eyes resolved/managed, RV for further discussion regarding SCC reoccurrence (did mention seeking Dr.JS at AVS for case continuity but O appear reluctant due to distance...) 

PLAN: send Hx to Paws at Prospect Vet for R eye condition 

Doing well 
Good improvement with 3 injections
Due for final today 4/4 
Synovan 0.79mls SQ 


Recheck in 3 months for a once off Pentosan injection top up 
Assess response to ointment for her hemangiomas on her belly 

HISTORY
owner said is improving with synovan

Current Medications= 
synovan, imiquimod cream
N = No Abnormalities Detected 

Examination:  
Gen App: bright, appears more mobile than prevoiusly

Oral C =
Abdo/GIT =
Eyes =
Ears =
Skin =
M/S = walks abnormally almost twists when walks. exuberant so difficult to examine fully, no obvious pain
Neuro = no delayed proprioception, seems more stable on feet than previous - not obviously weak as previoius

ASSESSMENT: 
good response to synovan so far

PLAN: 4th injection next week