C09986852 / invoice 10000

Reason: Recheck LumpsAppointment Notes: Overdue remindersHISTORY:  Recheck of lumps on the right shoulder. A lump on the distal right humerus, approximately 15mm, has remained unchanged over the last two months. A previous fine needle aspirate of this mass yielded adipose tissue. A more proximal 8mm mass on the right humerus is no longer palpable.A new mass has been identified on the left lateral thorax, located ventrally over the caudal ribs. This was aspirated today, and the sample macroscopically appeared to be adipose tissue, consistent with a lipoma.The owner reports an increase in hair shedding recently. Brushing is now performed daily, compared to weekly previously, with the brush filling with hair quickly.There is also a concern regarding a possible issue with the left hindlimb.Ralph is 10 years old. Current meds: noneVaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: History of a skin tag that was surgically removed.Access to toxins eg. Rodenticide: none EXAMINATION:Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: Palpation of the left stifle reveals instability consistent with a positive cranial drawer sign. There min to no pain on extension of the stifle. Ambulating normally, no palpable neck, spine, limb or joint pain otherwise.Integument/Ears: Increased shedding noted. A 15mm subcutaneous mass is present on the distal right humerus. A new subcutaneous mass is present on the left lateral thorax 25mm .Lymph Nodes: NSFEyes: NSFDemeanour/Behaviour: not discussed PROBLEM LIST:1. Multiple subcutaneous masses (right distal humerus, left lateral thorax)2. Left hindlimb instability and pain3. Increased shedding DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:1. Lipomas2. Partial cranial cruciate ligament tear, left stifle3. Meniscal injury secondary to cruciate ligament damage, left stifle? DIAGNOSTICS:Fine needle aspirate of the left thoracic mass was performed. Macroscopic appearance is consistent with adipose tissue.Radiographs of the left stifle have been recommended. ASSESSMENT: Ralph, a 10-year-old dog, presented for a lump check. Examination confirmed a stable 15mm mass on the right distal humerus, consistent with a previously diagnosed lipoma. A new mass on the left lateral thorax was aspirated and also appears to be a lipoma. Orthopaedic examination of the left hindlimb revealed stifle instability (positive cranial drawer) and pain on extension, highly suggestive of a partial cranial cruciate ligament tear with secondary meniscal damage. The cause is likely degenerative wear and tear. TREATMENT:  Conservative management and monitoring of the diagnosed lipomas. PLAN:Plan to admit for sedated radiographs of the left stifle ( peliv hips/stifles to be done) to confirm the extent of the cruciate ligament and meniscal injury. The owner will call to schedule this procedure.The procedure will require him to be dropped off in the morning, having been fasted from breakfast and with water removed from 6 am. He will be discharged in the afternoon.Continue to monitor the subcutaneous masses at home.Home into owner's care.History: Examination: Laboratory: Assessment: Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:History-Update:Consent has been given by the client to proceed with this treatment  -  Yes/No    Vital Signs    Weight: 28;