C10002352 / invoice 10000

Reason: Annual health check and vaccinationAppointment Notes: Paws App Details:Booking Type: Dog VaccinationBooking Vet: Dr Kristy HowardBooking Notes: Annual health check and vaccination Pet Insured: Yes  ------- Sms reply: YesVerified: NoHISTORYPresenting for: Coco presented for what the client believed was an annual vaccination appointment, however vaccination is not due until June. During the consultation, the client reported a small lump beneath the throat noticed less than a week ago.Historical Conditions: Previous cruciate ligament injury diagnosed by Steven with grade 2 instability in both back stifles, surgery recommended but not yet performed due to intermittent lamenessCurrent Meds: Simparica Trio monthly, Milbemax every 3 monthsOther: Client occasionally observes dog holding back left leg up when urinating and defecating, infrequent episodes of falling at dog park and sliding during runningEXAMIntegumentary: Small cystic lesion beneath throat with punctate opening on surface, expressed thick material of varying consistency and colour. Microscopic examination of expressed material revealed keratin and some protein, consistent with cyst. No cancer cells or significant RBCs observed.Musculoskeletal: Both patellae palpably luxate easily, consistent with previous diagnosis of grade 2 patellar luxation bilaterallyASSESSMENTSebaceous cyst - Benign lesion with characteristic microscopic findings of keratin and proteinBilateral patellar luxation grade 2 - Previously diagnosed, currently causing intermittent clinical signsPLANAdditional Discussion:- Cyst will likely refill and may have intermittent drainage through surface opening. Monitor for significant size increase or signs of infection, which would warrant surgical removal- Patellar luxation surgery recommended as soon as consistent lameness develops. Pre-surgical radiographs recommended for surgical planning and to rule out cruciate ligament involvement- Surgery may involve one or both stifles depending on surgeon's assessment- Post-surgical recovery involves 4 weeks crate confinement, pain medications, antibiotics, and weekly arthritis injections- Annual vaccination due in June - client travelling overseas early June so vaccination should be scheduled just prior to departureClient Comms:- Discussed benign nature of cyst and monitoring recommendations- Advised to book surgery consultation with Ashley for patellar luxation when lameness becomes consistent- Confirmed vaccination timing for June travel plans    Vital Signs    Weight: 8.06;