C10027797 / invoice 10000

HISTORYPresenting for: Winston, a boxer, presented for assessment of 2 lumps.Has been well otherwise.EXAMMentation: BART: 38.2°CHR: 108R: 24BCS: 4/9Abdominal: Normal on palpationCardiovascular: Heart sounds normalOral: Multiple epulides present on gums. Teeth appear very clean and do not require dental cleaningLumps: 1. 10mm pigmented raised skin mass, left lateral thigh. 2. 1-2cm soft subcutaneous mass, right medial stifleDiagnostics: Fine needle aspirate cytology performed on both masses. Left lateral thigh mass - scant agranular round cells, concerned for round cell tumour, possible melanoma. Right medial stifle mass - occasional rafts of vacuolated epithelial cells, suspect apocrine or adnexal massASSESSMENTCutaneous masses - Left lateral thigh mass concerning for round cell tumour (possible melanoma), right medial stifle mass likely apocrine or adnexal origin. Both require surgical removal given breed predisposition and cytological findingsMultiple epulides - Require removal to prevent food trapping and dental complicationsPLANMedications/Treatments:- Surgical removal of both cutaneous masses and epulides recommended. Cost estimate $1500-2200. Surgery scheduled for next Friday- Histopathology recommended for both cutaneous masses to obtain definitive diagnosis- Epulides will be trimmed, histopathology not required as these commonly regrowAdditional Discussion:- Vaccinations due in one month will be delayed until after surgery and suture removal- Any additional small lumps found at time of surgery will be checked and removed if indicated- Boxer breed predisposed to mast cell tumours, though these tend to be low grade. Multiple lumps common in this breed requiring ongoing monitoring

torn right dew claw right at the quick. AM/TE cut torn partwas very painful .adv O he may still need to come back in for pain relief but O to monitor if licking will need to put a sock or eliz collar on 

HISTORYPresenting for: Max, a boxer, presented for evaluation of small skin lumps present for approximately 2 weeks.Skin: Owner noticed a few small lumps, one of which has since disappeared. Owner initially thought they might be fleas or ticks. Attempted to pull one off which caused minor bleeding. Lumps have not increased in size. Previous boxer required frequent lump removals.Lifestyle Risk Factors: Visits dog park in mornings, runs with other dogs.EXAMMentation: BARBehavioural: Cooperative for examinationIntegumentary: Three small skin masses shown by O today. Two appear similar to each other - both on left side of body, one on chest area and the other on left thigh. Both are ~1cm diameter, hyperpigmented and have fur coming out of lumps. None appear to be causing pruritus or discomfort. One tiny skin tag on right side of muzzle - Owner reports one similar lump has resolved spontaneously.No murmurASSESSMENTCutaneous masses - Small skin masses - a couple looked follicular cysts. Given patient's age and breed, monitoring recommended with surgical removal if changes noted.PLANAdditional Discussion:- Recommend monitoring skin masses for the next few weeks- Surgical removal with histopathology recommended if masses: double in size within next couple months, become ulcerated/infected, or if new masses appear- General anaesthesia would be required for mass removal if indicatedClient Comms:- Discussed monitoring plan for skin masses- Reviewed concerning changes that would warrant earlier evaluation (growth, ulceration, new masses)- Explained surgical removal and histopathology process if needed in future