C09998057 / invoice 10000

    Vital Signs    

Reason: BleedingAppointment Notes: Paws App Details:Booking Type:  ConsultationBooking Vet: - Any -Booking Notes: Lesion on the nose that is bleeding Bleeding Pet Insured: YesSubjectivePresenting Concerns:-   Yuki presented for evaluation of a lesion on the right side of her nose. The owner first noticed it on Thursday as a pale pink spot. It reportedly became more raised and started bleeding on Saturday.  Historical Conditions:-   The owner reports no other significant medical conditions.  Skin & Coat:-   The owner reports the lesion on the right side of the nose is not itchy, and she has not observed Yuki scratching or rubbing at it.    Lifestyle Risk Factors:-   Chases possums.ObjectiveMentation: BAR  Wt: 21.4  BCS: 5/9  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: Friendly and social, but becomes stressed with attempts at sampling the nasal lesion.    Eyes: Clear. No discharge or erythema OU.  Ears: Clean with no discharge or erythema AU.  Nose: There is a plaque formation caudal to the right nostril, alopecic erythematous measuring aprox.1.7 to 2 cm. It has a pale pink discoloration with some dried blood present. The lesion is hard on palpation, with a texture that is different from the surrounding skin and bleeds easily with manipulation.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: Calculus and gingivitis absent. No masses or other lesions.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin. The skin on the belly is noted to be pale.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   A fine needle aspirate of the nasal lesion was attempted but was aborted as it was yielding only blood and was considered likely to be non-diagnostic.AssessmentCutaneous nasal lesion – DDx: Neoplasia (benign or malignant), inflammatory lesion, foreign body reaction, insect/spider bite reaction, trauma. The hard texture, focal nature, and tendency to bleed are concerning for a neoplastic process over an allergic or inflammatory one. Given the location, early diagnosis and treatment are recommended to prevent progression, as a larger lesion would be more difficult to manage surgically.PlanPending Diagnostics:-   Recommended a comprehensive pre-anesthetic blood panel to assess organ function and general health prior to anesthesia. The owner consented.-   Scheduled for a punch or wedge biopsy of the nasal lesion under general anesthesia on Friday.  Medications/Treatments:-   Advised against applying any topical treatments to the lesion before the biopsy.  Diet & Feeding Recommendations:-   Instructed the owner to fast Yuki from breakfast on the morning of the procedure (Friday). She can have dinner the night before and access to water overnight.  Additional Discussion:-   The owner is scheduled to drop Yuki off at 8:10 on Friday morning for the procedure.-   Discussed that the procedure will involve taking a small tissue sample for histopathology and will likely require  few sutures.-   Post-operative care will involve wearing a cone to prevent self-trauma to the biopsy site.-   The owner was informed that the clinic will provide updates on the day of the procedure and will call with the biopsy results once they are available.-   A cost estimate of approximately $1500 was provided for the biopsy procedure, and the owner consented to proceed.-   The rationale for proceeding with a biopsy rather than monitoring was discussed, emphasizing that early intervention is best, especially if the lesion is neoplastic, as treatment options become more limited as a lesion grows in this delicate area.    Vital Signs    Weight: 21.7;