C10014508 / invoice 10000

Reason: 3  More Lumps FormedHistoryPresenting Concerns:  Ziggy presented for evaluation of 3 new SQ lumps. The client reports 2 lumps on the hindlimbs have been present for approximately 2 weeks, and a third lump on the shoulder was discovered today. The primary concern is the possibility of new mast cell tumors, given the patient's history.    History Updates:-   Previously diagnosed with a SQ mast cell tumor, which was surgically excised with clean margins and a low mitotic count (<1).-   The client notes Ziggy has been pulling hair out around one of the new lumps.ExaminationMentation: BAR  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: Appears nervous and was hiding in the consult room.    Physical exam limited to the following areas today:  Abdominal: Palpation of the previous right lateral abdomen surgical site reveals no evidence of local recurrence.  Integumentary:-   Right hindlimb: A SQ/skin mass is palpable. clipped-   Left hindlimb: A SQ/skin mass is palpable.clipped-   Shoulder blade: A small, SQ/pink mass is palpable. clippedAssessmentMultiple new SQ masses – DDx: Mast cell tumor (new primary tumors), lipoma, histiocytoma, abscess, insect bite . Given the patient's history of a SQ mast cell tumor, the development of new mast cell tumors is the primary differential. The previous tumor had a low mitotic index, indicating a low but present risk of developing new tumors (11%).TreatmentPending Diagnostics:-   Plan for surgical excision of all 3 masses with wide margins.-   All 3 excised masses to be submitted for histopathology.  Medications/Treatments:-   Surgery is scheduled for Monday, 16/03, with a 9:30 am drop-off time.-   No food after midnight the night before surgery.-   A medical recovery suit will be used post-operatively.  Additional Discussion:-   An estimate for the procedure was provided and approved, totaling $2992. This includes $530 for histopathology of 3 specimens. The client will seek pre-approval from their pet insurance.-   The option of pre-anesthetic bloodwork was discussed and declined by the owner, as bloodwork was normal 5 months prior.-   The prognosis and risks associated with mast cell tumors were reviewed, including the statistical risks for metastasis (4%), local recurrence (8%), and development of new tumors (11%) based on the previous pathology report.-   The surgical plan includes intradermal sutures, and healing time is expected to be standard despite wide margins.    Vital Signs    Weight: 22.4;