C09989507 / invoice 10000

O came in to pay account asked about insurance said he is insured through Guide Dogs, JN advsied if we have the policy number we can do a GAP payment for him, alos he wanted physical script for thye dogs meds (attached). Client has gone away to get details & will return & collect scripts for medication & to pay account. JN

LS rang o to get payment over the phone. o going to come in and pay in cash as his card has been hacked on thursday. will also collect meds 

house visit - FNA lump + nail trim
very very anxious dog so o requested a house visit 
will be on gaba and trazadone given by another vet

last recorded weight 36.05 kg 

hx
with them since 9 years old, always been naughty at the vets 
only james cook university was able to do a physical exam; all opther vets just did what they could 
o main concern is nail trim 
has had mass tested - no real diagnosis - see prev attached hx
-gets loads of treats

physical examination
BAR, nice until you are going to do something to him, gives no warning at all, O are aware of his behaviour and have muzzle and understand staff safety, not stressing him out, etc. 
grade 1-2/6 heart murmur; not previously auscultated due to demeanour 
-care around face
cannot evaluate oral cavity because will bite, but seem genreally ok from what can be seen whilst panting, giving treats 
has had previous oral masses and teeth extracted
symmetrical face, symmetrical pupils 
no ear discharge overtly present, no ocular discharge overtly present 
BCS 7/9
good femoral pulses, strong 
popliteal LN symmetrical NSF

nails clipped- on floor with towel draped over face, v long quicks 
mass:
on left forelimb at point of elbow there is mass subcutaneous well demarcated, non mobile , fluid filled at sertain areas, there is a base to the mass, on acquireing sample too reactive around base was able to get sample but mostly fluid, able to remove around 1.3 ml of fluid
FNA sample form elbow mass 
spur cells, RBCS- heaps of rbc contamination 

OK for gabapentin 800 mg PO and trazadone 300 mg PO; the night before and 1.5 hours before vet visit. 
trail run this dose