C09987279 / invoice 10000

Hx:Since last week reluctant to go up or down stairsWhimpering a bit after jumping down from bedToday went down stairs okayLump LHS duration several years. Slowly growing in size. EDUD normally; no CSVDEx:BAR, anxious but very sweet boyCVS, resp: NADC1-2 G0-1GIT: Slightly tense but no fluid wave or focal painMSK: Ambulating well. Nonreactive to spinal, neck, limp palpation/ROM but did have a small whimper when picked up. Query discomfort from lump vs back?8 cm SC fatty consistency lump L axilla and flank; there is a 1.5 cm mobile SC fatty consistency lump (new lump) on belly as well.Otic/optic, LNs: WNLAssessment:Previous elevated GGT and lipase - await TAHPLumps DDx lipoma vs otherWhimpering - query discomfort from mass effect of large lump vs MSK injury.Plan:Await TAHP and FNAEstimate to be emailed for Sx removal of lump    Vital Signs    

Lab:CONCLUSIONS : Cytology indicates pyogranulomatous inflammation. COMMENT : Consider this result in context with the gross appearance of the affected area including potential cystic lesions or areas suggestive of follicular rupture (trauma?). A biopsy of the area with culture and histopathology may give more information as to the underlying cause of the chronic inflammation. Cytology by Dr Kristen H. Todhunter, BS, DVM, PhD, MANZCVS (Pathobiology) Verified by Kristen TodhunterCcom:Left VM with brief results and asked O to call back to report progress as INI may need further management/workupCcom:O says dog much improvedGave cyto results. No further followup if dog heals but if recurrent recommend allergy workup    Vital Signs    

Hx:Acute onset skin issue duration ~ 2 wks - started with bit of crust. Since Wed +++ pruritic and scratching around head and self-traumatising. Doesn't seem itchy anywhere elseNo VD; energy WNL. Maybe a small sneeze or cough once daily past few months.Diet: Chicken or turkey mince with veg. Kangaroo treats. Ziwi Peak fish and lamb.Parasite control: Bravecto UTDEx:Severe, pruritic, inflamed skin top of head with ulcerated areas covered in scab/crust where dog has self traumatised. Rest of skin NSF. Woods' lamp negative.Optic: No epiphora or blepharospasm. Globes look okayOral: C1/4, G0-1/4GIT: Comfortable and softMSK: BCS 6/9Otic: WNLCytology ears: NSFTape prep: Debris. No obvious ectoparasites or fungal elementsCytology skin scrape: +++ neuts ++ macrophages + mature lymphocytes; no obvious yeasts or bacteriaAssessment:Acute onset severe pruritic dermatitis localised to top of head. DDx contact dermatitis, allergy, secondary to insect bite/trauma/other insult, neoplasiaPlan:As highly cellular sample without obvious infection--sent to VN to double check no evidence for a neoplastic processEliz collar + topicals + Cytopoint. Holding pred as previous GI upset reaction and previous (mild) elevated liver enzymes.Recommend recheck TAHP at some point to ensure previous lipase and GGT elevation transient/iatrogenic and not persistingTx:Cytopoint 10 mg SCCleaned top of head with dilute betadineFollowed with topical Cytopoint + framixin (periocular region)    Vital Signs