C10006217 / invoice 10000

HISTORY:New lump on ventral chin noticed yesterday. Also while waiting for an appointment noticed a new skin lesion on cranial dorsum.Previous long term deep pyoderma skin lesions on RPL remain resolved, and RTL swollen hygroma appears also resolved. Tapered pred course finished approx 1w ago.Has otherwise been generally well, EDDU normal, no VRD, though O noticed has not jumped up to greet him the last 3d upon his return home as he usually does.EXAMINATION:Demeanour: BARCV: HR wnl, no murmurs or arrhythmias, MM p&m, CRT 1-2sResp: RR wnl, normal effort. No adventitious respiratory sounds auscultated. No coughing, sneezing or nasal discharge.Temp: Not takenInteg:- New skin lesion on cranial dorsum, in total approx 10x10cm: several ~1-1.5cm epidermal collarettes with surrounding erythema, some yellow crusting and small amount moist ulceration. No pain on palpation.- New round, well demarcated cutaneous mass on ventral chin, ~9mm diameter x 5mm deep, mid-dark red, mobile, non-painful.- RPL digital and lateral thigh skin lesions remain clinically healed.- RPL lateral thigh mass still present, size and appearance unchanged.- Elbow hygromas reduced to baseline normal, no further swelling of R elbow hygroma.Eyes: NSFEars: NSFOral: NSFNeuro: Normal mentation and gait.Abdo: Soft. No distension, palpable pain or massesPLNs: WNLMSK: WB x 4. No obvious lameness.UG: NSFRectal: External NSF. Internal NE.LABORATORY:- FNA chin mass: neutrophils ++, round cells (possibly histiocytes?) +++, rods +, cocci +- Impression smear lesion cranial dorsum: rods ++, cocci +, yeast +, neutrophils ++, eosinophils +- FNA R PL mass: mostly acellular, 1-2 epithelial cell with intracellular cocci +++ASSESSMENT:- Chin mass: possible histiocytoma vs other round cell tumour (benign vs malignant); requires second opinion/possible sending to pathology- Cranial dorsum lesion: likely superficial moist pyoderma with mixed bacterial infection- R PL lump: suspect lipoma with surface bacterial cocci contamination- RTL elbow hygroma swelling: extra swelling resolved, hygroma remains- RPL deep pyoderma lesions: remain clinically resolvedTREATMENT:Cleaned FNA sites pre and post aspiration with aqueous chlorhexidineCleaned cranial dorsum lesions with aqueous chlorhexidineConsent has been given by the owner to proceed with this treatment - YesPLAN:- Cephalexin 1500mg PO BID for 7d- Dilute betadine cleaning to back lesion BID- Neocort cream to back lesion BID for up to 10d- Pyohex wash full body 2x weekly- Recheck skin in 1 week. If back pyoderma responsive to Cephalexin, plan to continue this for 7d post clinical resolution. If non-responsive, recommend swab taken to send for C&S- Vet to seek a second-in practice opinion on chin FNA. If nature of mass still uncertain, recommend sending slide for patholoist cytology. Will contact O to advise.CLIENT COMMUNICATION:Discussed potential contagious nature of skin infection - assume yes until confirmed otherwise    Vital Signs    Weight: 49.5;