C10023724 / invoice 20000

Reason: ATTACHED - T4 And FNAT4 normal So needs to dietCytology:INTERPRETATIONSubacute-chronic septic pyogranulomatous, eosinophilic inflammation with mild fibrous tissueresponse and presence of mature anucleate squamous epithelial cells.COMMENTThe lesion is inflammatory with evidence supporting a foreign body reaction (to keratin?) andconcomitant hypersensitivity. Inflammation may be associated with a ruptured epidermal cystwhereby keratin released into the surrounding tissue elicits an inflammatory response. Secondaryinfection has likely occurred. Other causes may including foreign body response to exogenousmaterial, fungal infection, hypersensitivity, and neoplasiaSo recomm cont on abs and see what happens- hopefully resolves If is a cyst, may need to remove if causes ongoing issues in the area    Vital Signs    

Reason: TP Recheck PawAppointment Notes: cm- Summary: Lump on front right paw, weight management.Current history:- EDDU: Persistent lump on the front right paw. It was previously more purple but now appears drier. The owner reports occasional licking but no excessive attention to the area. The dog is also overweight, currently 41 kg. The owner is concerned about the weight despite feeding what is considered an appropriate amount for a smaller dog.- Current medication: Nil.- Known medical conditions: NIL.- Current diet: Billy + Margot beef-only biscuits, approximately 360-370g per day. Occasional liver treats for toileting and half a dental stick. No human food.**Clinical Exam** B&A - MM: pink refill < 2 secsLump noted on the front right paw, side of pad digit 5. It is firm and defined but not as purple as previously reported.-FURTHER MANAGEMENT/DIAGNOSTICS:- Fine needle aspirate (FNA) of the paw lump performed. Sample sent to the lab for cytology.- Blood test for T4 level performed to investigate potential hypothyroidism as a cause for weight gain.ASSESSMENT:- Paw lump: The lump on the front right paw is persistent. Differential diagnoses include a benign growth, cyst, or a tumour such as a mast cell tumour. An FNA was performed to obtain a sample for cytology. The owner was counselled that FNA is diagnostic approximately 80% of the time, but if the sample is non-diagnostic, an excisional biopsy may be required.- Weight management: The dog is overweight at 41 kg despite being fed an amount appropriate for a 32 kg dog. The owner reports no excessive treats or human food. The possibility of hypothyroidism was discussed as a potential underlying cause. A blood test for T4 was recommended and performed. Dietary changes were also discussed, including switching to a lower-carbohydrate diet by incorporating a low-fat wet food (e.g., kangaroo) and reducing the biscuit portion.Treatment:- FNA of paw lump performed.- Blood sample collected for T4 level.- Recommendations made to change diet to half biscuits and half low-fat wet food (e.g., kangaroo) to reduce carbohydrate intake and aid weight loss.PLAN:- Await results of FNA cytology and T4 blood test. Will call the owner with results, expected within 24-48 hours. If T4 is low, can run TSH etc on blood at lab- O aware this may be needed- If FNA is non-diagnostic, will discuss excisional biopsy if lump persists.    Vital Signs    Weight: 41.8;