C09983769 / invoice 10000

CLINICIAN: AC
PRESENTING COMPLAINT:  Recheck Stage B2 MMVD and Aortic heart base mass  - paraganglioma (SRT in June 2025). 
HISTORY: 
- Harvey has been well and no concerns. 
- Has been on Phenoxybenzamine 5mg twice a day
Pimobendan 5mg AM and 1.25mg PM
Telmisartan 10mg per day 
No concerns. 
CLINICAL FINDINGS:  BAR. Good BCS. HR 120, systolic murmur LHS. regular. Systolic BP is 120mmHg left foreleg. 
DIAGNOSTIC TESTS: 
-Repeat echo
- Heart base mass measures: ~2cm x 1cm in long axis (was 1.89 x 1.29cm). Short axis: 1.2 x 1.7 (was 1.89 x 1.4) 
LA/AO -  1.2 (<1.6) 
LAd is 2.65cm
LVIDd - 35.58mm
FS - 43%
DIAGNOSIS: 
Paraganglioma- static post SRT. 
Stage B2 MMVD - stable
PLAN:  
- Has been on Phenoxybenzamine 5mg twice a day
Pimobendan 5mg AM and 1.25mg PM
Telmisartan 10mg per day 
Recheck in 3-4months. 

CLINICIAN: AC
PRESENTING COMPLAINT:  Recheck paraganglioma aortic - 3 months post SRT 
HISTORY: 
- Harvey is going well 
- No clincial concerns
-recovered from his anal gland abscess
- No exercise intolerance. 
Continue Telmisartan 10mg per day
Continue Pimobendan 5mg AM and 1.25mg PM. 
Continue phenoxybenzamine 5mg twice a day 

CLINICAL FINDINGS: 
- BAR. Good BCS. MM pink <2. HR 120, systolic gr III/VI murmur. Dental disease on the molar teeth. 
DIAGNOSTIC TESTS:  
EPOC - WNL.

-BP is 150-160mmHg
Repeat echo: 
https://image-ase2.purview.net/instantshare?jwt=enc01-pKGxqzEc9TfYnb_NCjFbRksQt9RX-yZ8xCdV8HCzJKFIBVvvENVs1C_0J39bSEgI
Heart base tumour measures 1.89 x 1.29cm (long axis) amd 1.89 x 1.4cm (short axis)
MMVD with LVIDd at ~34-36mm FS is 47%
LA/AO : 1.11 (<1.5)
DIAGNOSIS: 
Stable aortic paraganglioma 3 months post SRT
Stable MMVD stage B2. 
PLAN:  
-Revisit in 3-4 months for repeat echo 
trazodone prior to next visit. 
Continue Telmisartan 10mg per day
Continue Pimobendan 5mg AM and 1.25mg PM. 
Continue phenoxybenzamine 5mg twice a day 

If having a general anaesthetic - discontinue telmisartan and phenoxybenzamine the day before the surgery. 

DATE/TIME of CONSULTATION: 13:18hrs, Sat 12/07/25
CLINICIAN: 
PRESENTING COMPLAINT: L anal gland abscess
HISTORY:
*Ongoing medicine patient - managed by AC for B2 MMVD and Aortic paraganglioma
*On pimobendan and telmisartan and phenoxybenzamine 
*Used to have anal gland sacculitis and require anal gland expression but haven't had one done in years
*EDUF well
*Scooting yesterday and owner noticed blood on the floor
CLINICAL FINDINGS:
Sub: BAR, cute dog
Obj: HR: 120, RR 30, MM pink and moist CRT<2 T: 38.3
Cardiovascular: grade V/VI heart murmur with left apical PMI, femoral pulses good and synchronous
Respiratory: normal respiratory rate and effort, normal bronchovesicular sounds on auscultation, no visible nasal discharge
Gastrointestinal: soft comfortable abdomen on palpation, no strong repeatable focus of pain,
Rectal exam: Enlarged and full right anal gland (when expressed, thick anal gland discharge), Ruptured left anal gland abscess
Musculoskeletal: no strong repeatable focus of pain on gentle manipulation of limbs and joints, no notable lameness on walk
Neurological: cranial nerves intact, no notable ataxia
Integument: no obvious lesions
Otic/Ocular: normal ocular and otic structures
Lymph Nodes: no peripheral lymphadenopathy noted
DIAGNOSIS: Ruptured left anal gland abscess
TREATMENT: 
*20mg/kg Amoxyclav PO BID for five days
*7kg Meloxicam dose PO SID for seven days
CLIENT COMMUNICATION/PLAN:
*If Harvey is licking perianal region, please put an ecollar on
*Recheck with regular veterinarian in a week