C09971206 / invoice 10000

History:
- Noticing Alfie getting older, difficulty with stairs, getting in/out of car, on/off furniture
- Slow to lay down
- Previous bilateral cruciate repairs
- Previous ear issues - now well controlled with quarterly ear treatment, no ear problems for a long time
- Current preventatives: Milbemax and Bravecto every 3 months

Physical Exam Findings:
- Behaviour: Good, quiet during examination
- Musculoskeletal: Arthritic changes in both knees, contributing to mobility issues
- Integument: Skin lump - back left leg + R lateral thorax

Diagnostic Results:
- Fine needle aspirate performed on skin lump - back left leg
- Cytology to be examined under microscope today; may send to lab if unusual

Assessment:
- Problem list:
1. Skin lump - back left leg + R lateral thorax
2. Osteoarthritis - bilateral stifles (post cruciate repairs)
3. Heartworm vaccination due

Plan:
- Antinol to start for arthritis - early days, very safe
- Review in next couple of months to observe response
- Anti-inflammatories available in future as arthritis progresses
- Heartworm vaccination administered

Communications:
- Discussed Antinol for arthritis management - starting early, safe to use
- Discussed that arthritis will worsen over time and additional medications (anti-inflammatories) available when needed
- Discussed yearly flea/tick injection option vs current tablet regimen - current tablets appropriate if reliable with administration

POC all healed 
back to normal food 
SW 

POC
wound looks great
No V
Passing stool
Temp 38.7

Cont lead walks and toilet breaks only, no off lead
RV in 1 week for final POC