C10011036 / invoice 10000

O brought Lenny back AMD swabbed the L earcytology consistent with malassezia +++ and neutrophils ++, some eosinophils seen too.Assessment: L malalssezia OE with marked inflam reaction.LMOM - confimr OE,Asked o to call and book an appointmetn with a nurse (AMD or CH ideally) to clean the L ear with epi otic and instill 1ml of keto/dex poloxamer

History: getting quite itchy. due for cytopoint.Has been licking aorund his tail base/ |AGs more recently and scooting.Usually gets worse when due for cytpoint and improves when on board.o unsure if lost weight - based on records here.Examine: BAR, pink moist mm, CRT<2secGrade 1-2 PD dz, with mostly buildup upper canines and carnassials - mild and not really affecting gums much.Marked saliva staining on RHS of perianal area.L ear smelly, with brown discahrge.AGs qtuie deep and hard to express. Both mild to moderately full. Got nippy when appleid full pressure to express them.lump on R lumbar back - measures 20mm diam, mobile, dermal. not infected / inflmaed at this stage.Second lump on R thoracolumbar back. lateral to spine, measures 7mm diam, alsoo dermal and mobile. >>>Both lumps have been aspirated in the past by SR and told not a concern. a dx never documented in the file.Aspirated both lumps for repeat cytology for no extra charge as unsure what the dx was.Lab: Both lumps consistent with epith inclusion cysts.Assessment: wt loss is not dramatic and has been going on for a while, so possibly insignificant.Teratment: cytopoint 40mg client comm: back for wt check in 2-3 weeks. if still keeps loosing weight, then recommend a blodo tset >>> Forgot to examine ear..

Cytopoint 40mg given s/c