C09981813 / invoice 10000

03/03/2026 Lab results show grade 2 MCT. Completely excised but lateral margins are 0.8mm. Tissue plane below shows adequate margin. 
Good prognosis with complete excision.

Options
Conservative - 1) Monitor for recurrence and excise if anything regrows
Oncology 2) If O' keen for oncology cons then would recommend we add the additional cytologic testing available for MCTs at Idexx to learn more about the mass. 

NL left msg on Susan's mobile to call and discuss 

Spoke to Wade and discussed above options. He will discuss with Susan but he seemed pretty happy just to monitor the site for recurrence. If any recurrence we will repeat excision with wider margins. Given location of mass the local lymph node would likely be intrathoracic so wouldn't be able to sample. Could attempt prescap sampling but given mass is ventral and caudal to prescap nodes I don't feel sampling would be overly helpful. 

If O' requested Oncology cons just to discuss options I suggested ACCWA. 


03/03/2026 Suture removal:
Sutures removed from all 4 sites and look great. Minimal crusted exudate but otherwise healed perfectly. Cone can come off as long as he doesn't attempt to lick or traumatize the area. 
Chill pill worked well, O asked about bathing him. I advised if he must then to ensure they surgery sites are dried completely. CP

03/03/2026 Incision split open

S/r this morning. All appeared well healed and has been 14d exactly from Sx. Went home and was looking fine at 2pm but then dog started licking and whole incision opened up. Full thickness and full length. 
This is a little unusual at this point in the healing phase. May suggest the movement in the post op period created only mild attachment as skin edges. 

Plan - recommended we repeat Sx to resuture. Est $600-700. Verbal approval from both owners. 

GA for suture wound

Current meds: nil - did get po D+ last time - unsure if related to metacam or panadol 

Preop exam: HR 132bpm, panting, stressed - chill pill has worn off. 

Anaes: 
Premed: medetomidine 0.1mL/meth 0.4mL IM - great sedation. 
IV induction: Propofol 2mL IV
Maintenance: Iso/O2. 
IVF @ 5mL/kg/hr
Monitored BP, HR, RR, Temp, ETCO2, SpO2. 

Anaesthetic comments: 30 mins in total. Stable. 
Recovery: 

Surgery: Trimmed wound edges back 2mm on each side (increased the margin for the MCT - silver lining!)
Suture material: 3-0 nylon simple interrupted sutures for length of skin incision. 

Discharge plan: Strict rest. Ecollar. 
S/r required: in 3 weeks
Meds: Meloxicam 0.4mL SC on recovery as single dose and suggested giving panadol as needed up to BID - 1.5mL of infant liquid. Keep diet bland and offered more prokolin paste also. 
Cephalexin 200mg BID. 
Next visit: 3 weeks for s/r with NL.