C10027565 / invoice 10000

 Lump RHS submandibularNoticed yesterdayNot quite herself but activeAte last night - no issues, ate as quickly as alwaysA little mild coughing at home - not hereDoes not eat bones, not a stick chewerEXAMSmooth, ovoid, slightly bilobed / additional smaller lump - main lump about 3cm diam longest lengthFNA - drop of blood tinged liquid - not terribly viscousNAD mouth, teeth good, no difficulty / pain opening mouth, no sublingual swelling / bloodT38.3Nothing in skin over lump ie no evidence g/sLHS s/m L/N WNRNAD LN prescap, popDDXlump node or salivary gland enlargementPLANFNA sent for cytologyStart ABs over the weekendYB:idexx 10/heam: unremarkablega (dom 3ug/kg; methadone 2.5mg/kg)induction: propofolmaintenance: iso/ o2examine oral cavity/pharynx/larynx/tonsilar crytpts/teeth: NSFclipped up swelling, no obv penetrating woundsre sampled lump from different angles and deep: small LN, foamy macsDdx:reactive LN, seems unlikely mandib salivary gland Plan:>send samples to lab for cytology>start amoxyclav>start melox

Bloods consistent with Pancreatitis Diet consistent of chicken tenders frequently, and some fatty meat over Christmas No improvements since yesterday Anorexic T 38.5 HR 112 no murmurs Pancreactic lipase elevated, constitent with pancreatitis Admit for hospital, fluids discharge tonight Ate chicken after fluids and pain relief home with amoxyclav, buprenophine Revisit 3-5 days, sooner if concerns Stick to low fat diet 

Letgargic, panting, shaking back end sagging Not jumping as much Hunched tense abdomen holding left hind limb up, left side back is drooping T 38.2 HR 100 no murmurs 1 vomit today Plan > Bloods> prevomax injection 2ml s/c > TGH with gabapentin R/v tomorrow