C09972868 / invoice 10000

Reason: Tumours/growths, Infected TailHISTORY:Presented for assessment of a large, ulcerated mass on the right flank. The owner reports the mass appeared and grew rapidly over the past 2/52. It is weeping a purulent discharge. The dog has a history of degenerative disc disease affecting four spinal discs. He also has multiple other masses which have previously been determined to be benign. The owner reports that despite his conditions, he still enjoys his walks and food, and has not had any "bad days". Appetite, drinking, urination, and defecation are reportedly normal. There is no vomiting, diarrhoea, coughing, or sneezing reported.Current meds: Meloxicam (Medicam).Vaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: Degenerative disc disease, multiple benign masses.Access to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: Ambulating normally, no palpable neck, spine, limb or joint pain. Known history of degenerative disc disease. Good muscle mass noted.Gastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): not graded- Abdominal: A large, ulcerated mass is present on the right flank, measuring approximately 35-40 mm in diameter. The mass is firm, weeping a purulent discharge with some fatty-appearing material within it. No detectable pain on abdominal palpation.- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: Skin appears to be in good condition. The ulcerated mass is the primary finding. The owner reports historical scratching has led to other skin issues previously.Lymph Nodes: NSFEyes: NSFDemeanour/Behaviour: not discussedPROBLEM LIST:- Rapidly growing, ulcerated, infected mass on right flank.- Degenerative disc disease.- Multiple other historical benign masses.DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:- Infected lipoma- Malignant neoplasia (cancer)DIAGNOSTICS:A fine needle aspirate and cytology were performed on the mass. The sample was taken from the mass itself after local anaesthetic was applied. The material collected included some purulent discharge and tissue. Microscopic examination revealed evidence of infection with pus present. There were also some cells that appeared atypical or "interesting", raising suspicion for neoplasia. The presence of fatty chunks in the discharge is suggestive of a lipoma.ASSESSMENT:The primary concern is the rapidly growing, ulcerated mass on the right flank. The rapid growth and ulceration are concerning for a malignant process. However, the presence of fatty material in the discharge and the dog's history of multiple benign masses (lipomas) suggest an infected lipoma is a strong possibility. The cytology was somewhat equivocal, showing definite infection but also some cells that could be consistent with cancer. The high anaesthetic risk due to age and pre-existing spinal issues makes surgical debulking or excision a high-risk procedure. A therapeutic trial with antibiotics is warranted to see if the mass responds. The lack of response would increase suspicion of malignancy.TREATMENT:- Amoxiclav prescribed for 3/52 to treat the infection.- Continue Meloxicam for degenerative disc disease. Steroids were considered for the inflammation associated with the mass but were deferred due to the risk of muscle wastage, which would compromise mobility given the existing spinal condition.- The owner was supplied with chlorhexidine solution for topical cleaning of the weeping mass.- A soft "bib-style" collar was recommended to prevent licking and allow the area to be covered without obstructing the dog.PLAN:Continue Amoxiclav for 3/52. Continue Meloxicam as directed. The owner is to clean the wound with chlorhexidine solution no more than once daily to avoid irritation. Re-assessment scheduled in 3/52 to evaluate the response of the mass to antibiotic therapy. The owner will monitor the size of the mass at home. If the mass continues to grow despite antibiotics, malignancy is highly likely.CLIENT COMMUNICATION:Discussed the diagnostic possibilities of an infected lipoma versus a cancerous tumour. Explained that the rapid growth is concerning but that lipomas can sometimes behave this way. The high risks associated with a general anaesthetic for surgery were discussed in detail. The plan to treat with antibiotics first was outlined as a therapeutic trial; if the mass improves, it is more likely a benign, infected process. If it worsens, cancer is the most likely diagnosis, which would then serve as a clear point for making quality-of-life decisions. The importance of maintaining mobility was stressed, hence the decision to avoid steroids which could cause muscle loss and worsen his ability to walk. The owner was provided with a brochure for at-home euthanasia services (Goodbye Good Boy) for future consideration if needed. The owner understands the plan and will return for re-evaluation in three weeks.    Vital Signs