C09998922 / invoice 10000

Reason: Lump Removal X3Appointment Notes: Overdue reminders ADReason: Mass excisionExamine:BAROral cavity exam under GA : grade 2 dental diz on some teeth with mild halitosis, no obvious extractions required. Laboratory: Preanaesthetic profile acceptedResults: CBC WNLBiochem: Mild stress hyperglycemia. Mild elevation BUN 9.0 (2.5-8.9) . Possible pre-renal as was fasted, but unable to obtain urine to confirm. Recc checking urine for ability to concentrate. Avoid NSAIDs in case as some renal compromise. Surgery/Procedure: US to look for bladder to obtain urine sample to test USG. Bladder very small. Can see a structure adjacent to bladder ciruclar, possible prostate? But cannot palpate rectally and cannot trace urethra through it. Assessment: ok to proceed with GA Anaesthesia:Premedication with methadone 0.23mL & acepromazine 0.06mL IM  Time: 0929Induction with 1.8mL alfaxalone IV	Maintained on Isofluorane & oxygenIV Hartmanns @ 5ml/kg/hrRecovery: UnremarkableComplications: NilSurgery/Procedure: Elliptical incision made around lumps, undermined to underlying SC fat. 3/0 PGCL to close SC fat. 3/0 nylon cruciate skin sutuesLump 1 - large lump dorsal back. This was incised after excised. Brown fluid with caseous chunks.Ddx infected cyst?Lump 2 - right lateral thorax. Similar appearance to 1 but smallerLump 3 - right dorsolateral abdomen.Treatment: Nails clippedBuprenorphine 0.01mg/kg SC on recoveryPlan: To go home with eCollar/shirt & Paracetamol 100mg + Gabapentin 100mg BID for analgesiaContinue amoxyclav course at homeAll 3 lumps sent for histopathology. Recheck/sutures out 10-14 days.Need to obtain 1st urine sample of the day for a few days and check USG for any evidence of inadequately concentrated urine. Consider referral for abdo US to investigate the unknown mass in caudal abdomen?Client Communication: STO before surgery informing of slight abnormalities on preGA bloods, ok to continue.    Vital Signs    Weight: 7.4;       

Appointment Notes: Overdue reminders NH SENT INSURANCE OFF ANDSM SOWNER    Vital Signs    

Reason: Seinor Pet/Lump Check Appointment Notes: Paws App Details: CT checkedBooking Type: Senior Health Check (7+ yrs)Booking Vet: Dr Lindy TanBooking Notes: Lump has grownHistory: Lump on back is bigger and over the past few days able to express some purulent material from it.Does not bother him.Otherwise fine. Examine: Mentation: BARPeripheral LN: NSFOral: MM pink, moist. CRT<2s. Not able to examine teeth properly Eyes: Eyes clear, no redness or discharge. No evidence of pathological ocular changes on external exam. Full ophthalmic exam not performed. Intact palpebral and menace response both eyesEars: Ears clean. No evidence of inflammation or discharge on external exam. Otoscopic exam not performed.Cardiovascular: Heart rate 120. No murmur or arrhythmia on auscultation. Pulse quality good and synchronous.Respiratory: RR and effort WNL. Lung sounds clear all fields.Gastrointestinal: Abdomen soft and non painful on palpation. No obvious organomegaly or abnormalities. Rectal exam not performed.Ugen: NSFInteg: Lumps as before except the one on the dorsal back is bigger and able to express purulent discharge from it MSK: Ambulating well. Full MSK exam not performed.Neuro: NSF, normal mentationTemp: not takenAssessment: suspected infected cyst vs other Ddx benign vs malignant Surgery is potentially curative. Plan: Start on amoxyclav 25mg/kg PO BID for nowBooked in for surgery this friday 3x lump removal + check teeth under GA Histopathology for all 3 lumps    Vital Signs    Weight: 7.4;