C10002911 / invoice 10000

Reason: Cyst On Chest BleedingAppointment Notes: Overdue remindersHX - LHS ventral chest has a bust cyst. Just noticed today  Normal diet is z/d.Has had diarrhea and vomiting worse than normal on and off since December. Went to a vet about this while on holidays, they suggested feeding her tuna - Added tuna in spring water on her food for about 2 months, She absolutely loved it. But owner thinks caused an increase in her diarrhea but equally could have been other factors re the ongoing IBD. Also signs had sarted before addition of tuna.  Diarrhea is colitis style. Gradually becomes progressively runnier then mucoid then staining  as she does multiple poos on each walk. Rarely any blood, sometimes has blood clots. Stopped the tuna for about a week but the diarrhea has continues.  Vomited once this mornining. Also occasional times in the last week. Already on psyllium husk and fish oil.Gave an ondansteron wafer todayEX Cyst on the LHS - looks like a sebaceous gland cyst - expressed a lot of thick white material out of it. Explored to make sure not a grass seed. Abdp palpation NAD - relaxed and comfrtable, no mass lesion.S Chest NAD, HR WNL MMs pink and moist.ASSESSMENT Ruptured sebaceous gland cyst. IBD flare up - related to addition of tuna? PLAN Start 600 mg cephlexin BID for cyst Owner wondering if should have further wokup - i.E. Ultrasound for IBD. Advised I would give longer off the tuna before booking in. Has only been a week and could take a lot longer on this to regain control again. Plan to feed z/d only strictly, and if not improving over another 2-3 weeks we can book in ultrasound. In the mean time start synbiotic DC - especially as will be on abs now. Have supplied a whole box. Depending on results of ultrasound could consider starting pred?    Vital Signs