C09971314 / invoice 10000

Appointment Notes: Zola Bullock (Dog) - Britt Dwyer - 0411588840 - Consultation [Veterinarian : Dr. Lauren Clancy (Preferred Clinician)] - Discuss next steps for her tumours/check other lumps  - Web BookingClient name: Britt DwyerContact number: 0411588840Email address: britt.dwyer@gmail.comPatient name: Zola BullockHistory:Issue of concern - recheck to discuss ongoing lumps /MCT. Seen 2 weeks ago for MCT.  Chest rads on the day found a suspicious mass, email sent to ARH, they replied (see Hx).  Overall uncommon for MCT to spread to chest, recc CT scan.  Also has narrowing of mid trachea - tracheal collapse vs external compression ?Since then - Zola has developed increased respiratory effort.  Her MCT on her LHL caudal stifle area has also increased in size, O says approx 20-25%, looking at it today though it is large for the area and fixed in position (not readily mobile).O also comments she seems larger around her chest - she has lumps in both L and R axilla regions, O says overall she seems larger here too.Still eddu normallyO said she got bad diarrhoea on the prednisone No current meds Last bloods 2 weeks ago -had mild reduced Hct and mild increased reticulocyts.  Also mild liver enzyme elevations. Examination:BAR.  BCS  5/9Euhydrated, no skin tentMouth = MM pk, moist, CRT<2sec, NADTeeth = grade 2 of 4 periodontal disease.Eyes clear, visual, NAD.  Ears clean, noninflamed, NAD.  No coughing in consultNose clean, no discharge NAD. LNs submandibular, prescapular, popliteal all WNL, NAD.* Lungs - there is visible increased respiratory effort, more so if there's any stress eg putting her on the exam today.  Lungs harsh both sides chest.  Tends towards open mouth breathing and panting as needed.  Her cranial chest current conformation looks unusual as well?- very solid / is there a mass somewhere here.  Heart sounds are normal, normal rate and rhythm, NMA, SSFP.  HR 100/minAbdomen - feels fairly solid cranial abdomen, may just be large liver but couldnt rule out internal mass * Ambulatory x4, walks abnormally in FLs more due to lumps in axilla creating physical issues.Urogenital desexed, NADNeuro mentation normal, gait normal, posture normal, nil visible concerns, full exam not performed, NAD. Temp 38.2 WNL* Skin exam - main concern is a large 40x40mm raised solid mass at caudal LHL in area of stifle /prox tibia, non mobile, previously FNA'd as MCT and is actively growing.  Small dermal mass R side abdomen - small MCT / less concerning.  Has large SQ masses in both L and R axilla, both FNA'd today as lipomas. Laboratory:FNA both L and R axiall masses - lipomas only Rechecked PCV/TP today given recent anaemia - PCV 36, TP 72, serum clear.  Borderline low PCV but opt to not proceed with Idexx CBC at this stage since no active worsening (perhaps money best spent elsewhere for now). Assessment:Problem list / DDx - 1)  Increased respiratory effort - concern of previous possible mass and also the narrowing of her trachea.  Concern of obstructive type situation or space occupying mass limiting respiratory capacity.  2)  Large and growing MCT on LHL - concern this may be high grade given appearance 3)  Lipomas L and R axilla - more a physical issue as are big 4)  Lower PCV / recent mild regen anaemia - would be concerned of mild background bleeding, eg GIT ulcer from MCT etc. Monitor closely / may need workup and Tx if so. Owner communication:My recommendations to owner - overall told O Zola has a lot of medical concerns currently.  I recommend best next step is a consult with oncology at ARH, and then O to decide if they wish to have the CT scan done for more information.  Once we know if chest is OK / rule in or out major disease, will then need to plan treatment for LHL MCT - will likely need a biopsy first for grading then planned removal its a large size.  Told O if high grade then Px can be poor if already spread.  Treatment:Nil todayRefer to ARH for consult to discuss next possible stepsO leaning towards maybe palliative, but since dog reacted to the pred to discuss with ARH when best next options may be Plan: As above    Vital Signs    Weight: 25.8;