C10006711 / invoice 10000

Reason: Check Lump On NeckSubjective: Presenting Concerns:  Marley, a 5-year-old female dog, presented for evaluation of a lump on the left side of her neck, just in front of the ear. The client also raised concerns about chronic itchiness and ear issues.    Historical Conditions:-   History of recurrent ear infections.-   Previous dental extraction.-   History of a cranial cruciate ligament injury in the left hindlimb, which was surgically repaired.-   Previously treated with a short course of steroids for allergies, though no definitive diagnosis was made.  Diet/Appetite:-   Royal Canin low-fat kibble.-   Kangaroo roll (recently introduced).-   Chicken roll.-   Omega Royal supplement.-   A raw chicken drumstick daily.-   A carrot at night.  Skin & Coat:-   Constant head shaking and scratching at ears.-   Constant licking of paws, particularly the front left paw.-   The client notes some of the paw pads are discoloured.-   The itchiness has been an on-and-off issue for the past 2 years since she was adopted.  Current Medications:-   Otoflush ear cleaner, which the client believes was compounded with a steroid by a previous veterinarian.  Additional Information:-   Marley was adopted as a rescue nearly 2 years ago.-   She has lost 8 kg over the last 2 years (intentional, was previously and is currently still overweight)Objective: Mentation: BAR  BCS: 7/9  T: Not taken  HR: 120  RR: 100  MM: pink/moist. CRT < 2sec.    Emotional Assessment:-   The patient appeared anxious during the examination and was reactive to having her ears handled.  Eyes: WNL . No discharge or erythema  Ears: The ear canals are not erythematous and have minimal discharge. The pinnae are very fluffy.  Nose: Clear, moist without discharge.  Oral: Calculus and gingivitis absent. No masses or other lesions.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally. No crackles or wheezes noted.  Abdominal: Soft and non-painful on palpation. No organomegaly or mass effects.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin. A firm, roughly spherical, non-painful SQ mass measuring approximately 0.5 cm in diameter is palpable in the left preauricular region. There is significant saliva staining on the fur of the left front paw compared to the other paws.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Rectal: Not performed.    Point of Care Diagnostics:-   Ear Cytology (Bilateral): No infectious organisms or significant inflammation seen.Assessment: Chronic pruritus and pododermatitis – DDx: Food-responsive dermatosis, atopic dermatitis, contact allergy, ectoparasitism. The history of chronic paw licking, head shaking, and recurrent ear issues, along with saliva staining on the LFL, is highly suggestive of an underlying allergic skin disease.    Cutaneous mass, left preauricular region – DDx: Follicular cyst, sebaceous adenoma, histiocytoma, mast cell tumour. This is a small, firm, non-painful mass. Monitoring is recommended at this stage as its small size makes fine-needle aspiration difficult and likely to be unrewarding.    Overweight – The patient has made good progress with an 8 kg weight loss over 2 years, but further weight reduction is recommended.Plan: Medications/Treatments:-   Dispensed Malaseb medicated shampoo. The owner was instructed to scrub it into the affected paws, allow 10 minutes of contact time, and then rinse thoroughly. This does not require bathing the entire body.  Diet & Feeding Recommendations:-   Recommended starting a strict elimination diet trial for 6-8 weeks to investigate a possible food allergy. Options discussed were:    -   A novel protein diet, such as a Prime 100 salmon roll.    -   A hydrolysed protein veterinary diet, such as Royal Canin Anallergenic or Hypoallergenic.-   It was emphasised that during this trial, no other foods, treats (including the nightly carrot), or table scraps should be given.  Additional Discussion:-   The client is to monitor the skin lump for any changes in size, shape, or character, or if it begins to bother Marley. They should seek re-evaluation if any changes are noted.-   A recheck examination was recommended in 6 weeks to assess the response to the diet trial. The client was advised to contact the clinic earlier if no improvement is seen after 4 weeks.-   Discussed future management options for environmental allergies if the diet trial is unsuccessful. These include daily oral medication or a monthly injection (Cytopoint) to control the itch.-   Today's charges will be for the consultation, ear cytology, and the medicated shampoo. The consultation notes will be provided for the pet insurance claim.    Vital Signs    Weight: 32.6;