C10004448 / invoice 10000

History: Has a new mass left side of cheek very similar to previous one removed. Otherwise seems to slow down and avoid laying on left leg sometimes, previous CCLR dx. EDUD normally.
Parasite control: Chew intestinal dewormer about once a month, sometimes misses. 

Physical Examination: 
CARDIO: Auscultation normal, no murmur. 
ORAL: MM Pink and Moist CRT < 2 seconds Dental disease 3/4 Severe wear on incisors and canines. Moderate tartar, mild gingivitis. 
RESPIRATORY: Bronchovesicular sounds normal, no crackles or wheezes, no effort
GASTROINTESTINAL: Comfortable on palpation
LYMPH: Symmetrical and of appropriate size
OPTIC: No pain or blepharospasm
OTIC: No scratching, pain, cerumen, or discharge. 
MSK Normal gait, no lameness noted, normal range of motion.
INTEGUMENT: Clean coat, left cheek 2cmX2cm mass, no erythema or swelling, attached firmly to skin. 
UROGENITAL: Soft bladder on palpation. No inflammation around genitals.
BCS: 4.5/9 

FNA: RBC, a few epithelial cells, a few round cells with loose ovoid nuclei small amount of light cytochrome. 

Assessment: Fit for vaccination. Mass likely sebaceous cell adenoma, benign. Monitor for any changes. We could remove if bothering the dog, as older and brachy would want pre-GA bloods. Could do dental at the same time. Discussed starting antiol for knee, or cartrophen especially in the winter months. 
Batch: Nobivac Flex DHPPi #2528102 + Oral Bb #2528102
Heart worm: 0.8ml sc 818230
Bravecto flea and tick spot on 6 months

Has had an injury to the LH in past where sx was indicated but O were unable to do so as needed a sialocoele sx removed priot to that and depleted funds
He is managing ok at home, going for walks as well. Cannot sit in normal position, positive sit test
He is otherwsie well
EDUD normal
On bravecto 3 monthly
Examine: heart and lungs normal sounds
LN's: wnl
Abdomen comfortable on palpation
BCS 4/9 healthy lean weight
Ambulating well in consult, mild thickening of the left stifle. positve draw sign
teteh clean, missin a few teteh form prior dentals 
Assessment: LH CCL rupture. O not going to pursue sx as coping well 
Treatment: Nobivac annual DHP + PIBB s/c
Proheart 0.8ml s/c
Plan: conitnue with bravecto 3 monthly
if lameness worsening or sudden lam RH revisit

Hx: Recently moved back from Northern Beaches, usually gets vax + HW inj etc, was due on October. Been well for most part, EDUF and energy/activity levels good, skin fine etc. Had a siaocoele surgery at some earlier age, but also some HL weakness in one side - owners considered surgery but ended up managing conservatively and has been ok since.

PE
BAR, a little reactive/mouthy but not specifically aggressive
Thoracic auscult NSF
RR/RE reg, mild general stertor breathing
MM pink
EENO & LNs NSF, teeth minimal dental disease be classic brachy mal-alignment of maxillary teeth
BCS 5.5/9
Abdo palp NSF
Skin/coat NSF
Gait - slight occasional HL ataxia but otherwise fluid mobility, muscle mass appears adequate as well.

Assessment: fit for vax, Nobivac C5, proheart given, applied bravecto topspot and sent home with worming
Owner to monitor mobility and control exercise etc