C10003173 / invoice 10000

Reason: Recheck - Call If NP Not In Appointment Notes: Overdue remindersNormal EDUD and BARThinks bottom unchangeOn z-cyte for OANot on cyclosporine - been 2 monthsSlight early ulcerated recurrence to the L - noted only after photo with flash and bathingAbdo relaxedLean condition Limited exam as aggressiveMms pink Teeth minimal dz as owner lifted lipsPlan: Start back on cyclosporine 3 daily for 1 month then REXVerified: NoReason: REX of perianal lesionHistory:Normal EDUDOn 4Cyte for OACyclosporine ceased approx 2 months agoPerianal pink area - owner reports no increase in size, appears similar to previous visitsNo scratching, head shaking, scooting, or lickingSome stiffness noted - still plays and runs but appeared tired after 500m walk in FebruaryBlood tests performed at last visit were normalExamination:BARPerianal area: pink scar tissue present from previous perianal fistula, some additional pink areas noted on examination today, clean and tidyAssessment:Early ulcerated recurrence of perianal fistulaPlan:Cyclosporine 3 tablets PO daily for 1 monthPhotograph of perianal area taken for recordsConversation with owner:Discussed option of surgical excision and biopsy if condition does not respond to medical managementOwner declined further diagnostics at this timeAdvised freezing cyclosporine tablets prior to administration may reduce GI side effects if V+ or nausea occurDiscussed OA management options if mobility worsens including joint injections (weekly for 4 weeks) and oral anti-inflammatoriesREX in 2 weeks (tentatively Thursday 26th at 09:20)    Vital Signs    Weight: 31.5;