C10004610 / invoice 10000

HISTORYBIB: Female and Male O (Male O takes notes throughout consult)Presenting for: Feline patient presenting for swollen lip lesion LHS, second occurrence after previous surgical removal in January last year of RHS of similar lesion (Dx 01.2024 Ulcerative, eosinophilic granuloma complex, cheilitis)- Previous blood tests 3 weeks ago - biochemistry unremarkableDiet: Hills Indoor 7+ dry food, amount weighed and measured daily, still gaining weightCurrent Meds: Bravecto up to dateLifestyle Risk Factors: Indoor cat with terrace access but recenty none, indoor onlyOther: Recent exposure to terrace plants may coincided with current episode but last time this was not possible. Taken away these plants now. EDUF WNL otherwiseEXAMMentation: BARWt: 6.72 kg (gained, previous weight 6.57 kg) 8/9Behavioural: Well behaved during examination, just very scaredOral: Large ulcerative lesion on dorsal L left lip sitting towards 204 surface, significant inflammation present, no obvious purulent dch, discomfort notedGeneralised otherwise NSF across rest og integumentASSESSMENTSuspected ulcerative EGC Eosinophilic granuloma - Recurrent lesion, likely allergic in nature. Previous histopathology confirmed eosinophilic granuloma. Current presentation and progression not consistent with neoplasia as this stage.Obesity - Weight increasing despite measured feedingMEDICATIONS:- Prednisolone tablets - 5mg tablet SID for 10 days, then 0.5 tablet SID for 7 days, then 0.5 tablet EOD for 7 days, then 0.25 tablet EOD until finished- Previous antibiotic injection given (2 week duration), no indication to repeat this today or consider alternative Abx courseRECOMMENDATIONS- Recommend transition to a weight management food like Hills Metabolic- Calculate portions based on 5-5.5kg target weight- Account for sedentary lifestyle in portion calculationsDISCUSSION- Steroid therapy may increase appetite and thirst- Monitor lip lesion for improvement over 2 - 4 weeks- Consider shortening tapering steroid course if rapid improvement seen- Remove access to plants and monitor for correlation with symptoms- Consider biopsy if no response to current treatment planPLAN- Return if lesion does not improve or gets worse e.g. becomes malodorous or shows signs of secondary infection- Recheck in 2 weeks to assess response to treatment, esp INI

HISTORYPresenting for: 9yo cat presented for inappetence and lethargy since 2d ago. Owner reports lip lesion not worsened but concerned not eating due to lesion.Historical Conditions: - Growth removed from lip 01/04/2024 - biopsy diagnosed as eosinophilic granuloma complex- Stage 2 kidney disease diagnosed FridayDiet:- Recently transitioned to Hill's z/d and z/d pate, not interested- Not eating since yesterday, minimal intake for 2 days prior. - Previously very food motivated, even after changing back to old food, still wouldn't eat it Current Meds:- Started z/d diet trial FridayLifestyle Risk Factors:- Indoor only with terrace accessEXAMMentation: Quiet, less vocal than usualBCS: OverweightT: NormalBehavioural: Standoffish, hiding under couchOral: Ulcerated lesions on upper lips, no discharge/not actively bleedingCardiovascular: NormalRespiratory: NormalAbdominal: NormalLymph Nodes: NormalIntegumentary: NormalNeurologic: NormalMusculoskeletal: NormalUrogenital: NormalRectal: NormalASSESSMENTInappetence and lethargy - 3 day duration, coinciding with diet change and lip lesion progressionEosinophilic granuloma complex - Active lip lesionEarly kidney disease - Stage 2 based on recent bloodwork, no clinical signsTx:0.7ml convenia SC PLANDiagnostics:- Full blood panel to assess kidney values and screen for other causes of inappetence, to call Julie with bloods- Oral temg OTM dispensed - 1 syringe BIDDiet Recs:- Continue offering both previous diet and z/d- Small frequent meals encouragedClient Comms:- Recheck tomorrow if not eating- May need hospitalization for IV fluids if inappetence continues- Blood results pending in 1-2 hours, will call with results

AM emailed hx to insurance for 20/6