C09978954 / invoice 10000

Reason: Lumps - KD OnlyAppointment Notes: Special payment terms exist, Overdue remindersHistory-Update:History:Presented for assessment of stiffness and soreness. Mack has been observed to be stiff when getting up and down, particularly on slippery floors. The owner reports he no longer "pops up" easily. A discussion was had regarding pain relief options for suspected arthritis. These included joint supplements (e.g., 4cyte), injectable treatments (Synovan or Beransa), and oral anti-inflammatory medication (Metacam). The risks and benefits of each were discussed, including the need for pre-medication blood tests for Metacam due to potential kidney effects.Referral History:At a previous visit, a lump on the chest was assessed and diagnosed as a lipoma.Examination:Appears bright but is visibly stiff and sore on rising.BCS: 8Normothermic.Euhydrated. Normal skin tent.CV: No murmurs or arrhythmias heard on auscultation.Resp: Normal bronchovesicular sounds bilaterally.Pink and moist. CRT < 2 secs.Dental grade: 4LN: Peripheral LN’s WNL.Integument: The previously noted lipoma on the chest now feels firm, suspicious for an infiltrative lipoma. Styptic powder was applied to a nail which was bleeding post-blood draw.Eyes, Ears, Nose, T: Eyes clear. Ears clean and non painful.Musculoskeletal: Stiff gait. Difficulty rising from a seated or lying position.Neuro: Normal demeanour. No neurological concerns.Abdomen : No obvious pain or abnormalities detected on palpation. Comfortable.G/U: Bladder comfortable. Genitalia normal.Assessment:Suspected degenerative joint disease/osteoarthritis causing pain and stiffness.Firm subcutaneous mass on chest, potentially an infiltrative lipoma.Treatment:In-house bloods collected for pre-anaesthetic/geriatric profile.Beransa injection administered for rapid pain relief.Dispensed Metacam oral suspension.Dispensed 4cyte liquid.Plan:Await results of in-house blood panel this afternoon. Will call the owner to discuss results.Commence Metacam 1x daily for 5 days, then use as needed for pain, pending normal blood results. Owner advised to monitor for vomiting, diarrhoea, or lethargy and to cease medication if these occur.Commence 4cyte liquid at 2mL daily long-term for joint support.Surgical removal of the chest mass would be required for definitive diagnosis and treatment, which would involve a general anaesthetic. The owner has declined this at present.Re-evaluation as needed.    Vital Signs    Weight: 33.5;       

Reason: Lump Check Appointment Notes: lgHistory:Mack presented for assessment of multiple subcutaneous lumps and a general check-up. Owner reports Mack is turning 14 in November. He is not on any current medications. He has some signs of arthritis. Walks once daily in the park. His teeth are noted to be in poor condition. He has maintained weight, currently 32kg. The owner is concerned about the lumps, potential arthritis, and overall quality of life, including the possibility of future blindness from cataracts and cognitive decline. A discussion was had regarding quality of life assessment, including monitoring for distress, restlessness, and the impact of potential sensory loss (e.g., blindness).Referral History: No previous history provided.Examination:Bright, alert, and responsive.BCS 6/9.Normothermic.Euhydrated. Normal skin tent.CV: HR= 130bpm. No murmurs or arrhythmias heard on auscultation.Resp: RR=pant. Normal bronchovesicular sounds bilaterally.Pink and moist. CRT < 2 secs.Dental grade 4/4. dental disease.LN: Palpable subcutaneous masses on the chest, soft and mobile, consistent with lipomas. Mutliple other umps not tested today. Peripheral LNs WNL.Integument: Multiple soft, mobile, subcutaneous masses on the chest. A fine needle aspirate of one lump yielded a clear, oily substance, highly suspicious for a lipoma. Coat soft, skin non erythematous. No evidence of ectoparasites.Eyes, Ears, Nose, T: Bilateral lenticular sclerosis noted, consistent with early cataract development. Ears clean and non painful.Musculoskeletal: Mild signs of arthritis suspected based on age and breed. No lameness noted. Fully weight bearing.Neuro: Normal demeanour. No neurological concerns.Abdomen : No obvious pain or abnormalities detected on palpation. Comfortable.G/U: Bladder comfortable. Genitalia normal.Assessment:-   Multiple suspected lipomas. Differentials include other forms of neoplasia.-   Suspected osteoarthritis.-   Advanced dental disease.-   Age-related changes: early cataracts, potential cognitive decline.-   Weight loss.Treatment:-   Fine needle aspirate performed on one subcutaneous mass.Plan:-   Pain management for suspected arthritis to be initiated with Panadol. Owner advised on dosage (Children's Panadol 100mg/mL concentration, 3.2mL dose).-   If Panadol provides insufficient relief, will consider joint supplements (e.g., 4Cyte) or NSAIDs (e.g., Metacam). Pre-anaesthetic blood test to check kidney function would be recommended prior to starting Metacam.-   Owner advised on monitoring lumps for changes in size or character. Surgical removal is an option but would require a general anaesthetic and pre-anaesthetic workup. Currently, the lumps do not appear to be impacting mobility and O would prefer to not go down that pathway due to age. -   Provided owner with information on arthritis management, including supplements containing fish oil or green-lipped mussel.-   Client education provided regarding quality of life assessment, particularly in relation to signs of pain, distress, cognitive decline, and vision loss.-   Follow-up as needed.--- 20/08/2025 08:15:40 AM GL1:Examinations - Resolved -    Vital Signs    Weight: 32;       HeartRate: 130;       RespirationRate: pant;       CRT: 2;       MMColour: pink;       BodyScore: 6;       

Reason: Skin IssueAppointment Notes: Special payment terms exist, Overdue remindersHistory: over last month has been getting scabs on back and gradually getting a bit worse and spreading. Has been a bit itchy. Owner can't think of any changes to diet, environment etc and not really had skin issues in the past Examination: redness scabs and hair loss over mid to lower back. No sign of any parasites/fleas. Ears NAD rest of body appears ok but hard to see under furLaboratory: Assessment: allergic dermatitis Treatment: medicated shampoo and conditioner twice a week, pred reducing dose, would be handy if they got him shaved so can see skin easierConsent has been given by the client to proceed with this treatment  -  YesPlan: if not settle then will need to recheck and further investigation--- 02/08/2022 08:21:29 AM JMO:Examinations - Resolved - SMS sent KY    Vital Signs