C10027321 / invoice 10000

Reason: LumpAppointment Notes: Paws App Details:Booking Type: Consultation - Skin / Ears / EyesBooking Vet: Dr ArjunaBooking Notes: Storm has a lump/pimple on her belly with fluid.Pet Insurance Provider (if applicable): BupaClient Present: VickiPre-consult nurse: EmilyLump been present for 3 weeks, slowly growing. Not irritating her. Happy to do KC vacc and SR12 today. Vaccination status:Flea & Tick prevention: bravecto chewWorming: milpro 3 monthlyHeartworm: SR12Other medication: noDiet: science diet kibbleMicrochipped: yes, on fileVIP: noInsurance: yes, bupaPre-consult nurse:History:Annual vaccination and heartworm prevention visit for both Storm and Ninja. The vaccination schedule was consolidated. Storm also presented for investigation of a new, rapidly growing lump on her abdomen.    Patient Status:  Current Diet: Not discussed  Current Medications: Not discussed  Parasite Prevention: Owner uses externally sourced Bravecto q 3 months. Milpro was dispensed for intestinal worming.  Vaccination Status: Due for annual kennel cough, annual heartworm, and triennial C4.  VetLove VIP: Ninja is an existing member. Storm was signed up for the monthly plan during the visit.    EDUD: Not discussed  Vomiting: No  Diarrhoea: No    Owner Observations:  A lump on the belly started as a pimple approximately 3 weeks ago and has been growing. Storm was a bit stiff last night after a run but is fine today.Examination:Mentation: BAR  Wt: 23.8 kg  T: Not documented  P: Not documented  R: Not documented  MM: pink/moist. CRT < 2sec.  Hydration: Normal  Eyes: Corneas/irises/lenses/sclera/conjunctiva/palpebrae no significant abnormalities. (Anterior/posterior chambers and fundus exam not performed)  Ears: Clean, no inflammation  Nose: Clean  Throat: No tracheal sensitivity; no palpable masses.  Oral: Very light grade one plaque.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: Clean full coat. A fleshy, soft, hairless lesion is located close to the left second-to-last nipple with an abnormal hair follicle growing from it.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.Diagnostics:A fine needle aspirate of the abdominal skin lesion was performed.  Cytology is pending in-house review.Assessment:-   Annual health check and vaccination.-   Abdominal skin mass.    Differential Diagnoses:  For the skin mass: Benign glandular cyst (hair follicle or sebum gland origin), other benign vs. malignant neoplasia.Additional Discussion:-   Treatment Expectations: The vet will call with cytology results. If inconclusive, surgical removal while the mass is small is the next recommendation.-   Side Effects: Discussed potential for vaccine reactions for both dogs (lethargy, itchiness, hives) as the Lepto vaccine is new to their systems.-   Client Questions: The client asked about the cost of the visit and the VIP plan options for Storm.Treatment:-   Nobivac Flex DHPPI (C4) reconstituted with Nobivac Lepto 2, administered over the right shoulder (Batch 2532515, Exp 07/27 and Batch A003A01, Exp 10-26). This is the first dose of the primary Lepto course.-   ProHeart SR-12 injection administered between the shoulder blades (Batch 818230, Exp 02-28).-   Nobivac BB oral vaccine administered (Batch 2532515, Exp 07-27).-   Milpro dispensed for intestinal worming.-   A single nail on the front foot was clipped.Plan:-   Storm was signed up for the monthly VetLove VIP program ($40/month). Financial options were discussed in detail.-   Both Storm and Ninja received a triennial C4/Lepto combination vaccine, a ProHeart SR-12 injection, and an oral BB vaccine.-   Both dogs were dispensed Milpro for intestinal worming.-   The owner will continue using externally sourced Bravecto for flea/tick control for both dogs and declined the 12-month injection due to cost.-   A fine needle aspirate of Storm's abdominal skin mass was performed for cytology - suggestive of a benign squamous or glandular cyst-   Discussed options for Ninja's nail trims, including nurse appointments with pre-visit oral sedatives (Trazodone/Gabapentin).    Follow-up:  Both dogs to return in 2-4 weeks for their second Lepto vaccine booster (reminder set for 13/04). Surgical removal of Storm's mass may be performed at that time if indicated.Nurse Recall Plan:Nurse: Unspecified  Timing: Call 1-2 days post-visit    Status Check:-   EDUD: Normal/Abnormal-   Post-visit concerns: Check both dogs for any signs of a vaccine reaction (lethargy, itchiness, hives).-   Response to treatment: Describe  Follow-up:-   Follow-up questions: Ask if the owner would like to book a nail trim appointment for Ninja.-   Future appointments booked: Vaccine booster for both dogs booked for 13/04.  Vet Flag:  If concerns arise, schedule vet phone consult at: Time/Date    Vital Signs    Weight: 23.8;       MMColour: Pink;       BodyScore: 5;       DentalGrade: 1;       CRT: < 1 sec;