C09973308 / invoice 10000

Lump removalPremed ACP 0.33ml and methadone 1.6ml scInduction aquafol 13.3ml IVMaintenance IsoET tube 8.5Chest xrays showed enlarged heart VHS 11-12. Lungs have cardiogenetic pattern.Give frusemide 1.8ml IVIV fluidsSurgery- elliptical incision, tying of vessels with 3-0 PGCL. There was a very large vessel on the caudal edge incision, after tying off left a small lump.Closed sc with 2-0 PGCLClosed skin with 2-0 supramidClavulox 600mg slow IVmeloxicam 1.3ml scPlan: home with meloxicam 2.2ml sid for 5 days. s/o in 10-14 days. Mass sent off for histopath.

Prozac/fluoxetine 40mg (1.1mg/kg) SID - can goup to 2mg/kgCatapres/clonidine 3x150mcg BID-TID (0.01mg/kg) - can up to 0.05mg/kgGabapentin 800mg @ 1 SID/PRN (23mg/kg)PE:very mild dental tartaroverweight/obeseSC firm mammary mass around 3cm in diameter at L 4th nippleRest of mammary glands NADLN NADAx:OverweightPoss DJDAnxiety - good controlled most of the timeMammary mass - neoplasia (benign/malignant)PLAN:Rec joint supp eg fish oil/green lipped mussel, gave dosesContinue weight lossnew script for fluoxetine 40mg SID, Catapres/Clonidine 150mcg x 3 BID (can be given TID)O sitll has gabapentin, advised can give 800mg, then maybe 400mg pm or after 8 hours if needed (at least 1-2 hours prior to O leaving home)Gave est for lumpectomy, O keen

LAB:Blood tests (Chem 17, CBC, SDMA, TT4) all WNLVIA ultrasound - Obesity with fatty liver - nodular lesions within the liver are likely benign change (hepatomas; nodular hyperplasia) rather than early malignant lesionsPLAN:Rec weight loss, start with reducing food intake, use low cal/fat wet food, lean meat, instead of dry food, aim at ~870 calories per day.Aim at 1-2% of weight loss per week, ie 340-680g/week. Target weight ~25kgDiscussed briefly Hill's Metabolic diet but needs to be exclusive, difficult when there are two dogs and Moira does have some separation anxiety (destructive, chews at door/furniture when Jo/O is away, even other human and dog are at home), on meds and lots of toys around.