C10003474 / invoice 10000

HISTORYPresenting for: Ginger presented for health check to assess healing of lesion between digits of right front paw following emergency visit approximately one week ago. Owners also concerned about possible urinary incontinence over the past week and requesting mobility assessment.Historical Conditions: Recent thyroid surgery with treatment progressing well and patient stable. Previous emergency visit for focal folliculitis between digits 4 and 5 of right foreleg with cultures pending.Drinking/Urination: Possible urinary incontinence noted by owners over past week.EXAMMentation: Clinically appears well for ageT: 38.1?CHR: 86 BPMMM: Pink MMEyes: Clear with nuclear sclerosis presentEars: Clean, no odour or dischargeNose: Clear naresOral: Grade 2-3 tartar with associated gingivitisCardiovascular: Normal rate and rhythm, no arrhythmia or murmurRespiratory: Clear lung sounds bilaterallyAbdominal: Soft and comfortableIntegumentary: Lesion between digits 4 and 5 on right foreleg showing significant improvement per owners, no longer troubling patient. Mild pododermatitis present.Musculoskeletal: Right forelimb lameness present. Hindlimb stiffness with difficulty getting up and down. Normal proprioception.Diagnostics: Urine sample collected - USG 1030, pH 6, 3+ proteinuria, calcium oxalate crystals present, no bacteria observed. Acupuncture session performed targeting anti-inflammatory points for osteoarthritis support.ASSESSMENTFocal folliculitis right foreleg - significantly improved, cultures pending from emergency centreOsteoarthritis - affecting mobility with forelimb lameness and hindlimb stiffnessProteinuria with calcium oxalate crystalluria - possible medication-related (calcitriol), significance to be determinedPost-thyroid surgery - stable and progressing wellDental disease - grade 2-3 tartar with gingivitisMild pododermatitisBody condition - carrying slight excess weightPLANDiagnostics:- Repeat urine sample collection to confirm persistence of crystals and proteinuria- Blood work coordination with specialist centre to assess kidney function- Request cystocentesis and UPC ratio if proteinuria persists- Abdominal imaging recommended to evaluate for calcium oxalate stonesAdditional Discussion:- Osteoarthritis management to be adjusted pending specialist blood work results- Monitor lesion healing and await culture results from emergency centre- Weight management discussion for optimal body condition

History concern: Recent bilateral thyroid gland removal and spleen removalHas been doing wellLast visit one week ago at SASHHas developed a mass between digits of one hind footalso getting stiff againcurrent medications: Levothyroxine 400mcg (100) 1.5 tablets morning and nightCalcitriol 0.25Ug 100  capsules 1 capsule morning and nightpreventatives: as previousDiet: as previousother:history of pancreatitisClinical Examination Eyes:clean, no dischargeEars:clean no discharge or odorOral Cavity:Grade 1-2 tartar and gingivitisIntegument:healthy coat and skindoes have firm swelling Front right bw digits 4/5-old had for years, been aspirated previously does have firm swelling Hind Left by digit 3/4-newdoes have soft fluctuant grape size swelling dorsal tarsus Left leg. Cardiovascular: normal rate and rhythm, Grade one heart murmur, MM pink, CRT <2Respiratory:normal rate and rhythm, bilaterally normal chest soundsAbdominal: soft and comfortableMuskuloskeletal: shuffling lameness front limbs, stiff in hind. reluctant to sit, proprioception normal discomfort in lumbosacral regionLymph Nodes:palpably normalReproductive:neuteredOther:noAssessmentOAsuspect ID cystsmild tartarrecent splenectomy and thyroid gland removalDiagnosisas aboveTestsFNA dorsal tarsal mass left hind leg: fat cells onlyFNA  hind L ID mass: predominantly inflammatory (neutrophils and macrophages BUT concern about some clusters of densely staining cytoplasm cells with large nucleous and some motosisTreatmentneocort to apply topically to ID massacupuncture todayBL40, GV14, ST 36, GV 20, BL 23/24/25, LI11Plancall with cytology resultswill get back to client regarding enquiry into calcium powder and tumericlediscussed antinol and synbioticClient communication 6th of August 2025advised chat to specialist regarding calcitriol vs calcium carbonate if wanting to persuecan reach out to supplier of turmerical to make sure okay for dogs with pancreatitisdiscussed cytology of ID mass- Bec happy to send off to pathologist for review

June 2025- summary straight from SASH notesThyroid massBILATERAL thyroid massesThyroid:? In the anticipated regions of the thyroids, there are focal, irregular, moderately enhancing, soft tissueattenuating masses with multifocal, rounded, non-enhancing, fluid attenuating areas.? Left thyroid mass is larger, with maximal dimensions of ~ (3.35 cm x 3.02 cm) x (4.42 cm) (H x W xL).? Maximal dimensions of the right thyroid mass is ~ (1.92 cm x 1.84 cm) x (4.62 cm) (W x H x L).? There is slight neovascularisation at the cranial aspect of the left thyroid mass, with a plexus ofsmall, tortuous vessels present.? Adjacent to the left thyroid mass, there is slight intrafascial fat stranding.Splenectomy27/5/25 To remove splenic massHistopathological diagnosis of benign lymphoid hyperplasiaHeart MurmurGrade I-II/VI focal over mitral valveThyroid Carcinoma27/5/25 Bilateral thyroidectomyHistoryDr Ingrid GoodmanPresents for ionised calcium check. Well at home, great appetite, normal thirst, stool and urination.Current medication:1. Levothyroxine - recently increased to 400mcg PO BID2. Calcitriol 250ng PO BIDBilateral thyroidectomy and splenectomy 3 weeks agoDiagnostic Result