C10014402 / invoice 10000

Reason: Lumpectomy
Presented by: Kristen
Admitted by:  ET
Relevant History:

Pre-operative examination: 
Demeanour: BAR
HR: 104
RR: 32
MM's: Pink
CRT: <2sec
Temp: NT
Dental Stage: NC
BCS: 5
Vaccination Status: N
Microchipped: Y

Laboratory/ Pre-GA Bloodwork: (Prep Profile II / Basic Bloods)
Basic Pre-GA Blood Test:
PCV: 47.9 % (Dog: 37-55 )
TP: 71 g/dL (Dog: 5.6-8.0 )

Assessment: Minor ALP elevation as before
ASA: 2

Pre-med: Prevomax 1.3ml s/c 9:49
Methadone (10mg/ml): 0.4 mls, Route: IM, Time: 10:44
Medetomodine: 0.07 mls, Route: IM, Time: 10:44
Sedation comments: Moderate

Induction: Propofol (10mg/ml): 1.8 mls, Route: I/V, Time: 11:05
ET tube size: 6 mm, Difficult induction?: N
Catheter size: 22 G, Site:LF
Maintenance: Isoflurane
IVFT Type: hartmanns crystalloid, Rate: 55 ml/hr

Anaesthesia comments: Stable

Surgical report: (Vets to write)
small ~1cm pink mass removed from R skin fold below the eye
Closed he wound intradermally

Recovery: 
Slow recovery to extubation. 
Not a fan of ecollar so just sat moping until discharge

Treatment:Meloxicam 0.52ml s/c 11:25

Medications to go home with:
Amoxyclav 250 x 10 3/4 bid
Meloxicam13kg dose sid for 5 days
 
Plan: 
Revisit in 10 days for wound check (with VET)
Must wear E-collar until healed

Reason: Facial swelling/growth examination
Presented by: Kristen
History: Approximately 4 weeks ago owner noticed what appeared to be a grass seed lodged in face.
 Owner managed to pluck it out, scab formed, dog rubbed face and scab fell off.
 Area then started to swell. Swelling has shown cyclical behaviour - deflating and becoming flat with no fur (pink patch), then swelling again.
 Dog was staying at property with tall uncut grass with grass seeds at time of initial incident.
Known problems: Seasonal allergies causing pruritus in spring/summer.
 Has habit of face rubbing particularly after meals.
Current Medications: Nil

Examination -
Demeanour: BAR
BCS: 5
CVS: Sinus arrhythmia noted - HR varies with breathing (normal finding)
RESP: NAD
LN: NAD
GI: NAD
INTEG: Red swollen growth on face medial to rt eye.
 Approx 4mm diam - sits between medial canthus rt eye and skin fold of nose
 No discharge noted
 Long-standing dark pigmented lesion also present on face (described as beauty spot, present for years)
MSK: NAD
OCULAR: Bilateral epiphora, otherwise NAD

Assessment: Facial lesion of unknown aetiology.
 Differential diagnoses include papilloma, cyst, inflammatory lesion secondary to foreign body, or neoplasia.
 Rapid onset suggests inflammatory cause, however persistence after 4 weeks raises concern for other pathology.
 Location close to eye is concerning.

Diagnostics / Work-up Options:
Surgical excision with histopathology recommended

Treatment:
No antibiotics prescribed pre-operatively to allow natural state for surgical assessment

Plan: Schedule surgical excision early next week with narrow margins due to proximity to eye.
 Very limited margins so advise excise with minimal margins initially
 Submit excised tissue for histopathology.
 If malignant on histopath, further treatment options to be discussed based on tumour type.

Anal Glands Expressed:
Comments:
Left - Half full, thick
Right - "

Restraint used: food distraction
Owner able to restrain: Y

Patients behaviour: calm

Next due: As needed