C09975146 / invoice 10000

Reason: Lump Check - SCSubjectivePresenting Concerns:  Storm, an 11-year-old male Cocker Spaniel, presented for evaluation of multiple skin lumps and intermittent raspy breathing.    Historical Conditions:-   The patient has a history of similar skin lumps that were previously examined at this clinic.  V/D/C/S:-   The owner reports that the patient's breathing is sometimes raspy.  Skin & Coat:-   The owner reports multiple lumps on the patient's tummy and one on an ear. The lump on the ear does not seem to be irritating.  Current Medications:-   The patient receives a wormer and flea treatment; specific products were not named.ObjectiveMentation: BAR  Wt: 17 kg  BCS: 5/9  T: 38.4  P: 96  R: 20  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Eyes: Clear. No discharge or erythema OU.  Ears: Clean with no discharge or erythema AU. A mass is present on one ear pinna.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: The veterinarian expressed concern regarding the health of the molars, which are predisposed to disease in this breed.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: A sebaceous adenoma is present on the abdomen; this was manually expressed and produced a sebum-like material. A second mass is present on one ear pinna.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   Fine-needle aspirate and cytology of the ear mass: The sample was hemodiluted and non-diagnostic. It contained round cells of varying sizes but did not contain mast cells.AssessmentCutaneous masses - A sebaceous adenoma was identified on the abdomen. A second mass of unknown type is present on an ear pinna. Cytology was non-diagnostic but ruled out a mast cell tumor. Excisional biopsy with histopathology is recommended to obtain a definitive diagnosis.    Dental Disease - Significant dental disease is suspected, particularly affecting the molar teeth. A full dental assessment and treatment under general anesthesia is warranted.    Raspy Breathing - DDx: Laryngeal disease, tracheal collapse, chronic bronchitis, cardiogenic causes. This was reported by the owner, but no abnormalities were noted on physical examination today.PlanPending Diagnostics:-   The cytology slide from the ear mass is being held at the clinic. The option to send the slide for pathologist review for approximately $260 was discussed.  Medications/Treatments:-   The sebaceous adenoma on the abdomen was manually expressed and cleaned in the clinic.  Additional Discussion:-   It was recommended to schedule a general anesthetic procedure within the next 3 months. The plan includes pre-anesthetic blood work, a full dental assessment with dental radiographs, scaling, and polishing, and surgical excision of the ear mass.-   The possibility of tooth extractions was discussed, and the owner was advised to be prepared for an additional cost of approximately $500.-   A detailed estimate was provided and discussed:-   The total cost for the pre-anesthetic blood work, dental procedure, lump removal, and histopathology is approximately $2,270.-   If histopathology is declined, the cost is reduced by $410 to approximately $1,860.-   It was strongly recommended to submit the excised mass for histopathology to obtain a definitive diagnosis. If declined, the veterinarian will hold the sample in case it is needed in the future.-   The clinic's VIP wellness plan was discussed. The cost is $45 per month for a one-year commitment. Benefits include a free consultation (a $104 credit for today's visit if the owner signs up within 2 weeks), a free annual blood test, a $250 discount on the dental procedure, and 10% off services and medications.-   An email with the estimate will be sent to the owner (Leah Anderson).-   A text message with information about the VIP plan will be sent to the phone number ending in 092.    Vital Signs    Weight: 17.7;