C09998731 / invoice 10000

PRIMARY PRESENTING COMPLAINT:Rapidly growing oral mass on lip/ rostral jaw area over past 2 weeksOTHER COMPLAINT:Bilateral otitis externa with malodorous discharge; faecal incontinence in house; dental disease with fractured teethHISTORY:Mass started as small red spot approximately 2 weeks ago, has grown significantly since thenPresented by MIL per O request. Last Normal - 2 weeks agoLast Ate - Breakfast at approximately 0730 hours (though owner reports food still remaining in bowl suggesting incomplete consumption)EDUF normally. No regular V+/D+Medicine Hx - Possibly on medication for "ears" issues (owner unsure of current ear medications)Diet - Special diet mentioned, specific details not providedVacc Current - utdWorming Hx - unsureHeartworm - unsureMicrochip - Not mentioned/not scanned during this consultEXAMINATION:12yo dog with rapidly growing rostral oral mass, enlarged L submandibular LN, chronic otitis externa, dental diseaseAttitude - BARBody Score - 8/10Hydration status - wnlTemperature - not takenHeart - HR=PR: 96bpm. strong synch pulses. no murmur notedRR - panting. normal bv lung sounds. Dental Score (0-4) and comments - red, irregular wide based lesion from encompassing 401/402 +/- 301/403. CRT - immediateEyes - NVLEars - Bilateral otitis externa, severe malodorous bacterial infection - under treatment regimeAbd Palpation - UnremarkableGastrointestinal - No Sig FindingsUrogenital - No Sig FindingsSkin - wnlMusculoskeletal - No Sig FindingsNeurological - No Sig FindingsLymphatic - Left submandibular lymph node enlarged compared to rightOther Key Findings - Oral mass on lip/jaw region, rapid growth over 2 weeks; fractured teeth presentASSESSMENT:Primary concern is oral neoplasia with differential diagnoses including peripheral odontogenic fibroma (benign, dental-related), melanoma (can be amelanotic), fibrosarcoma (locally destructive), or squamous cell carcinoma (aggressive). Enlarged ipsilateral submandibular lymph node raises concern for metastatic spread or reactive lymphadenopathy. Concurrent dental disease and chronic bilateral otitis externa requiring management.PROBLEM LIST:1. Oral mass, lip/jaw region, rapid growth over 2 weeks 2. Left submandibular lymphadenopathy 3. Dental disease with fractured teeth 4. Bilateral otitis externa, chronic, malodorous DDx:Oral mass DDx: - Peripheral odontogenic fibroma (benign, dental-related) - Melanoma (pigmented or amelanotic) - Fibrosarcoma (locally invasive) - Squamous cell carcinoma (aggressive, metastatic potential)Lymphadenopathy DDx: - Metastatic neoplasia - Reactive lymphadenitis secondary to oral pathologyDISCUSSED:Owner informed of need for urgent investigation of oral mass due to rapid growth and concerning presentation. Explained differential diagnoses ranging from benign dental-related masses to malignant neoplasms including melanoma, fibrosarcoma, and squamous cell carcinoma. Discussed that amelanotic melanomas exist despite lack of pigmentation. Emphasized importance of not performing other dental work until mass is identified to avoid potential seeding if malignant. Explained that malignant oral tumors can metastasize to lungs and lymph nodes. Owner informed that treatment plan depends on histopathology results and staging. If left untreated or diagnosis delayed, potential for: metastatic spread to lungs and distant lymph nodes, local bone destruction and invasion, loss of treatment options if disease progresses. Owner given option to proceed same-day or schedule next week. Cost estimate of $1,500 provided. Owner expressed concern about recent feeding and aspiration risk; vet explained can give medication to expedite gastric emptying if proceeding today. Owner to discuss with son (dog's actual owner) and decide on timing.TREATMENT PLAN:General anaesthesia for diagnostic workup including dental radiographs to assess bone involvement, incisional biopsy of oral mass for histopathology, and fine needle aspirate of left submandibular lymph node. Further treatment plan to be determined based on histopathology results - may require wide surgical excision with margins, partial mandibulectomy, or referral depending on diagnosis and staging. Dental extractions and other dental work to be deferred until after mass diagnosis confirmed. If proceeding same-day, prokinetic medication to be administered to reduce aspiration risk given recent feeding.PRESCRIPTIONS (ON-GOING): NEXT VISIT:Results expected from histopathology laboratory. Follow-up appointment to be scheduled to discuss results and determine definitive treatment plan based on diagnosis. May require staging (thoracic radiographs, further lymph node assessment) depending on histopathology results.The above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.

History:Medication:Examination:Ocular: no periocular discharge, visual, menace plr palp normalOral: dental gradeLymph nodes: peripheral within normal limitsEars:bilateral OE -yeast and cocci seen on cytology R ear worse than L earCardiovascular: No audible heart murmur, HR in sync with pulseRespiratory: No abnormal lung sounds, trach pinch negativeAbdominal: comfortable on palpationMusculoskeletal: Ambulatory, full MSK exam not performedUrogenital: NADNeurological: Normal mentationC5 vacc enro dex ear drops script written

Dear RebekahThanks for the communication and for waiting for my response.I do think I would treat this as a mild case of SLO with high dosage of omega 3 fatty acid supplementation. You could add this to the base diet at 1g/5kg bwt using fish oil capsules. This would probably be the most cost effective. The other drug intervention you could consider is oclacitinib (Apoquel) at 0.4 to 0.6mg/kg q12hrs for 4 weeks. There have been some cases of SLO that have responded to this drug and this would also benefit the mild pruritus.I hope this advice is usefulBest wishesMandy