C10030458 / invoice 10000

HISTORY
visit for mass check on lips
past 5-6wks: gradually growing R lower lip - O reported minor trauma on lower jaw when playing with other dogs (but long time ago according to O) 
-> no other traumatic event O can think of, unsure if had insect bite or not 
otherwise EDDU normal, doing well 

Current Medications= nil 
N = No Abnormalities Detected 
behaviour = was very good boy throughout today: muzzled for FNA just in case but no aggression and tolerated well -> very sweet boy (loves pats) 

Examination:  
Gen App: BAR 
Pain: 0/5 
MM / CRT: pm<2
Oral C = R lower lip: 3-4cm diameter swelling under the mucosa/SC layer (no obvious mass or lesion visible externally) - no bleeding/discharge, no pain on palpation 
-> FNA cytology (NO obvious pus/discharge drawn out while FNA syringe): moderate neutrophils (toxic change), cocci++, lots of RBCs
dental: 1/4 (very clean teeth, no calculi buildup or major gingivitis) 
Skin = suspecting old scar on lower chin (suspecting from traumatic event that O mentioned above) 
Neuro = n

ASSESSMENT: acute onset of R lower lip swelling -> FNA cytology revealed moderate neutrophilia with evidence of bacterial infection 
-> top DDx: abscess secondary to trauma/insect bite (given Hx & lesion location), granuloma, no evidence of neoplasia today but cannot rule out, open 
=> discussed medical approach vs surgical exploration: O interested in Sx procedure but due to no pain and no obvious pus drainage today, O agreed with medical Tx first 

PLAN:
- amoxyclav 500mg BID for 10d 
- macrolone 20mg tapering protocol: 1.5tabs SID for 5d -> 1tab SID for 5d -> 0.5tab SID until finish (total 15tabs) 
-> RV in 2wks and discuss if Sx procedure needed - O open for discussion 

HISTORY
visit for 4th synovan 
doing well, EDDU normal, no concerns 
O thinks he is improving alot with synovan + warmer weather (spring-summer) - much worse in winter 
-> O agreed with 6mthly synovan booster & can have discussion about whether to try beransa/gabapentin (as discuss in previous visits) - not interested atm 

TREATMENT: 1.13mL SC dorsal thorax (no reaction with injection with male O holding well) 

PLAN: RV in 6mths for synovan booster + discuss if further OA Mx meds needed or not (as colder season approaches) 

In for 3rd synovan injection today.
BATCH NO: 24239V

History: Doing well at home, owner has noticed an improvement in his demeanour and energy levels since starting the medication. Owner reports that Rondo is less stiff and seems happier in himself. Owner is motivated to help Rondo lose weight.

BAR in consult - well behaved for injection, owner lightly restrained
Temp/HR: Not taken
EDUD normally - no issues from previous injections so far

Plan: 4th injection with vet to check progress

BES