C09992825 / invoice 10000

Anaesthesia:
Anaesthesia:
Muzzled size 1 basket muzzle
Premed:  Medetomidine 10 mcg/kg / 0.3 mg/kg Methadone      Route: IM
Inadequate sedation achieved, IV catheter placed right cephalic
Induction: Alfaxan 10mg/ml                Route: IV  to effect

Intra-op complications: Nil
Recovery: Smooth

Area(s) radiographed: lat and dp of both FL paws and elbow

Abnormal findings: Varus deformity at elbow and valgus at carpus.
Severe arthritic changes in both elbows evident; osteophytes on medial epicondyles.
Both FL digits no abnormalities identified.

Ear exam:
Left ear moderate erythema and brown ceruminous discharge
Right ear mild erythema, very little discharge
Otoscopic exam, both TM intact.

Cytology: epithelial cells and debris, no evidence of cocci or yeast.

Lump on left ventral abdomen, alopecic, round raised 2 cm in diameter. 
FNA: clear aspirate
Cytology: 3-4 mesenchymal cells/hpf on vacuolated basophilic background

DDx: soft tissue sarcoma

Laboratory:
CBC: Mild non regenerative anaemia Biochemistry: Moderately elevated ALT, ALP

Treatment: Cytopoint 10 mg SC
Batch/Exp: 828805/01.2027

Plan: 
1. Recommend OA management e.g starting beransa
2. Recommend abdominal U/S to assess liver
3. Recommend surgical removal of lump and histopath

Discharge: Discussed above with O. 
1. O declined Beransa as has read up on it and not comfortable with it.
Discussed trialing Amantadine and potentially considering CBD oil. O consented to starting amantadine, script provided.
3 mg/kg BID for 3 weeks and review
2. Has previously had ultrasound done by Jarrad at Swan Vet in 2024 with no abnormalities identified.
Advised O that things may have changed since then and would still be ideal to repeat U/S before considering starting on liver supportive supplements as per previous
3. O will consider removing lump but not priority right now.

Reason: Courtesy phone call - owner was quite busy, said she will call tomorrow
Nurse: SKW
History: ears
     Demeanour:
     Eating/ Drinking:
     Toileting:
     Any concerns?
     
Treatment:
     Medications being given: dermotic
     Patient taking meds as prescribed? still shaking head a little bit. 

Assessment: not scratching and OR no discharge but occasionally shakes head. Only cleaned ears with epi-otic once since last seen. advised revisit if not 100% - o declined

Next Appointment: