C09995135 / invoice 10000

Reason: Health CheckAppointment Notes: Booked Online: 03/03/2026 17:35:40 PMBooking Type: Skin, Ears, Eyes or LumpsBooking Notes: Health checkLumps on bodyOwner Name: Shirphine LohOwner Email: shirphine@gmail.comOwner Mobile Number: 0404097238Pet Name: AlfiePet Species: DogWeb BookingClient name: LohContact number: 0404097238Email address: shirphine@gmail.comPatient name: Alfie  ------- Sms reply: YHISTORY:  Presented for a health check and assessment of multiple lumps. Alfie is a 13-14 year old dog. The owner reports he is generally healthy, with a good appetite, though is a fussy eater. No vomiting or diarrhoea reported. Normal water intake. An unusual behaviour of licking the air is reported to occur intermittently, approximately once every couple of weeks. The owner has noted three lumps: 2 pimple type lumps around the neck, and a larger one on the belly. There is also a history of some stiffness and a leg giving way on stairs, suggestive of arthritis.Vaccinations are lapsed; a course was started in 2024, but the booster was missed. Has previously received a Beransa injection for arthritis. Current meds: noneVaccination: Lapsed. Requires a restart of the primary course.Parasite Prevention: Not up to date.Pre-existing conditions: Arthritis.Access to toxins eg. Rodenticide: none EXAMINATION:Body Condition Score: 4/9Pain Scale (0-4): Discomfort noted on musculoskeletal palpation.Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory:thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge.Neurological:neurologically no significant findingsMusculoskeletal: Moderate stiffness noted. Groaning upon manipulation, suggestive of arthritis.Gastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):Advanced dental disease (grade 4/4) with severe gingival recession, particularly around the canine teeth. Multiple incisors are mobile. This is the likely cause of the lip-licking behaviour.- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: Three skin lumps identified:1. Subcutaneous, soft, mobile mass on the ventral abdomen (belly).2. Small, pimple-like dermal mass on the right side of the neck.3. Very small dermal mass on the midline of the head.Lymph Nodes: Mildly enlarged mandibular lymph nodes, likely reactive to dental disease.Eyes: Bilateral nuclear sclerosis noted. Vision appears clinically adequate.Demeanour/Behaviour: Quiet, alert, and responsive. PROBLEM LIST:1. Advanced dental disease (Grade 4/4) with multiple extractions required.2. Multiple skin masses for investigation.3. Arthritis.4. Lapsed vaccination status.5. Parasite prevention not current. DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:1. Advanced dental disease.2. Lipoma (ventral abdominal mass).3. Skin masses on neck and head require histopathology.4. Osteoarthritis. DIAGNOSTICS:A fine needle aspirate (FNA) was performed on the soft mass on the ventral abdomen. The sample consisted of fatty material, consistent with a lipoma. ASSESSMENT:Alfie is a 13-14 year old dog presenting for a health check and lump assessment. The most significant finding is severe, advanced dental disease causing oral pain, which is the likely cause of his lip-licking behaviour and fussiness with food. Multiple teeth require extraction. Three skin lumps were identified; the one on the abdomen is consistent with a benign lipoma based on FNA. The other two small dermal masses require excisional biopsy for definitive diagnosis. He also shows clinical signs of osteoarthritis that require management. TREATMENT:  - Beransa injection administered today for osteoarthritis pain management.- Recommended restarting monthly parasite prevention with NexGard Spectra or Simparica Trio. PLAN:- Booked for a day procedure on 09/03/2026 for dental treatment and lump removal.- The procedure will include a pre-anaesthetic blood test, dental X-rays, scale and polish, and surgical extractions of multiple teeth (estimate includes 2 canines and 4 incisors).- The two small dermal masses on the right neck and head will be surgically excised and submitted for histopathology.- The owner is to fast Alfie from midnight the night before the procedure (water can be available). Admission is at 8:00 am.- Post-operative checks will be scheduled, at which time the vaccination course can be restarted.- Home into owner's care. CLIENT COMMUNICATION:Discussed the findings of the examination, particularly the severity of the dental disease and its connection to his discomfort and clinical signs. Explained the necessity of the dental procedure, including probable extractions and the use of dental X-rays to guide treatment. Discussed the nature of the lumps; the ventral mass is most likely a benign lipoma that does not require removal, while the other two require excisional biopsy for diagnosis. Provided an estimate for the dental procedure and lump removals, totalling $2,887. Explained that this is an estimate and the final cost may vary depending on the number of extractions needed, which will be confirmed via a phone call on the day of the procedure. Discussed long-term management options for arthritis, including the Beransa injection given today and the option of oral pain relief, noting the need for blood tests for long-term medication. Advised on restarting monthly parasite control. Pre-operative instructions for the procedure on 24/03/2026 were provided.    Vital Signs    Weight: 9.6;