C09986799 / invoice 10000

Follow up call post lumpectomy (EYE). O tells me Tilly is doing really well and has left her eye alone. o questioned about the stitch sticking out. i checked with Dr emily and she tells me 5-0 surgical is dissolving, however if it remains present for weeks later may need to come and have us remove it. Suture material is not bothering Tilly.

Reason: In for removal of an eyelid mass under local anaesthetic.History:Exam: BAR, vitals wnl, mm pink, heart and lung sounds normal, nad on abdo palpation, coat and skin normal, ln normal, mentation normal. Anaesthesia:Placed alcaine eye drops into left eye and administered lignocaine around the surgical site.Surgery:Removed meibomian gland tumor. Closed with 3 stitches using 5-0 surgical.Plan:Back in 10-14 days for suture removalHome with Chlorsig in left eye bid for 5 days.Home with meloxicam 0.1mg/kg sid for 3 days.

VISIT SUMMARY: Tilly, a 14-15 year old female dog with a history of bilateral cruciate repair and Cushing's disease, presented for a pain management review. The owner reports increased soreness and reluctance to walk. After discussing the risks and benefits of various analgesics in the context of her Cushing's disease, a trial of a non-steroidal anti-inflammatory (Previcox) and Panadol was initiated.SUBJECTIVE:History: Owner reports increasing soreness and exercise intolerance. Tilly will sit down during walks. This has been occurring despite previous treatment with Beransa. Appetite and thirst are reportedly normal.Existing medical conditions/diagnoses:- Bilateral cranial cruciate ligament rupture (repaired 2019)- Cushing's disease (hyperadrenocorticism), secondary to a suspected pituitary tumour. Not currently treated.- History of cataracts and other minor procedures requiring anaesthesia (9 total).- Suspected meibomian gland tumours on one eye, which bled a few weeks ago.Current medications: Previously on Beransa injections for approximately 12 months. Owner feels it is no longer effective and is concerned about a possible adverse reaction (transient shallow, rapid breathing) on 13/11/2025 after a dose was administered. She has had Panadol twice. No supplements.OBJECTIVE:- Physical Exam:- General Appearance: BAR, appropriate mentation, hydration, demeanour. Warty growths noted.- Eyes: Warty-like lesions on eyelid margin, consistent with meibomian gland tumours. The owner reports a recent bleeding episode from one lesion.- Ears: unremarkable but otoscopic exam not performed- Oral Cavity: CRT <2sec, no malocclusions, no calculus, no gingivitis- CV: no murmur, regular rhythm, synchronous regular femoral pulses- Resp: normal respiratory character and effort- Neuro: appropriate mentation, unremarkable gait. Detailed neurological exam not performed. Owner reports some muscle wastage.- Integument: clean, healthy coat without matting- Abdomen/GI: NAD on abdominal palpation, BCS 4/9- Musculoskeletal: Generalised arthritic pain suspected, particularly affecting elbows and other joints beyond just the stifles.- Urogenital: external genitalia unremarkable- Peripheral lymph nodes: palpably normal- Rectal: not performed- Diagnostic Results: Bloodwork performed one month ago showed elevated liver enzymes. Kidney function was normal.ASSESSMENT:- Multicentric osteoarthritis, likely contributing to current clinical signs of pain and exercise intolerance.- Cushing's disease (unmanaged), which may complicate the choice of NSAID therapy due to potential effects on liver function.- Suspected meibomian gland adenomas.PLAN:- Diagnostic/Treatment Plan:- Discontinue Beransa injections as per owner's preference and perceived lack of efficacy.- Commence trial of Previcox at a low dose for 2-3 weeks to manage arthritic pain.-Dispensed 12 tab 227mg previcox, give 3/4 of a tablet sid.- Owner to administer half a 500mg Panadol tablet alongside Previcox for multimodal analgesia.- Discussed risks of NSAID use, particularly with pre-existing elevated liver enzymes secondary to Cushing's disease.- If the trial is successful, will need to monitor bloodwork (liver and kidney parameters) in a couple of months to ensure safety of long-term administration.- Recommendations:- Recommended starting a joint supplement containing fish oil and green-lipped mussel (e.g., Antinol).- Advised owner to monitor for any adverse effects of new medication, such as vomiting or inappetence, and to cease medication if they occur.- Discussed eyelid masses. Surgical excision is the treatment of choice. Offered to perform the procedure here if they prefer.