C10008235 / invoice 10000

Hx: ears improved, still scratching a bit. Lump left hind has shrunk a little, not licking it etc. 

Examine: bilateral resolving OE, left ear still has some debris. 
Raised red mass has somewhat 'dried out', 12mm diameter on left plantar tarsus. 

Assessment: likely histiocytoma, had one before. FNA collected today in consult room as Polly becomes quite distressed away from O. 

Plan: would be difficult area to sx excise therefore if confirmed on cytology, recommend waiting 12 wks. 
Continue Dermotic bid another 5 days and Otoflush in left ear only sid. 

9/3/26 - s/t Troy - cytol non diagnostic but not indicative of histiocytoma so tentatively booked for sx on Friday but Troy will measure it the day before and call to cancel if shrinking. Aware will need to heal via second intention with bandaging if going ahead with removal. 

Presented for -  lump check RHl + ears
O noticed smell from ears, also shaking head intermittent. has noticed lump RHL caudal metatarsal, has been bleeding. Polly not licking it. otherwise well no V or D 

Current medications: nill
Parasite control: 

Mentation: BAR, anxious
EDUF: nad
MM: pink moist
CRT: < 2sec
DS: 1/4 some staining to teeth no gingivitis
Skin tent: < 1sec
LN: wnl
Ears: bilateral odour, inflamed mild, ceruminous exudate
Eyes: clear
Thyroid: nad
HR:  100 reg
Chest Auscultation: normal bronchovesicualr
Abdo Palpation: soft
BCS:5/9
Temp: np
Rectal Exam:  np
Skin: RHL caudal just under hock- raised lump with scabby surface, inflamed approx 8mm oval
Joints/Gait: ambulating well in consult
Urogenital: nad
Vaccination status: UTD
 
Problem list: 
1) lump RHL
DDx: FB v histiocytoma v abcess

Treatment in clinic:
tried to FNA lump- no aspirate, bleed on probe- cleaned with chlorhex
cytology ears- malasezia ++ L, + R, TM intact and some ceruminous collection, mod inflamm

Plan: 
dermotic 0.7ml bid both ears 7 days
otoflush daily 30 min proir to ear med
amoxyclauv 500mg bid 5 days po
meloxicam sid 5 days 1.5mg/ml
re-check ears and lump 10 days

Communication: discussed with O monitor for regression of lump, O keen to have removed if not resolving sooner as due to have baby soon. re-check recommend both ears and lump

Patient presented today 30min post-ingestion of 5cm diameter corn cob. No obvious sign of discomfort or sickness reported by owner. 
EDUF: well, no V/D
Medication: nil

Vitals: HR 100 = PR, RR: panting, T ne 

CRT <2sec, MM p/m, soft and comfortable abdomen, LN WNLs.

Induction of emesis: redivom
2.8ml Administered SC 
Vomitus was composed of undigested gastric content including unchewed dog biscuits, carrots & corn with a brown discoloration of the gastric juices.  30mins post administartion of redivom white foamy gastric content was observed (bile). 

Sent home. Monitor for further discomfort/v+
Discussed likely found evidence of full corn cob which was ingested but wont know for certain/there may be a piece in there which could still cause obstruction. Discussed scope if owners were interested, but owners happy to go home and wait and see.