C09973353 / invoice 10000

OR in Canberra over weekend, started itching like crazy. Gave him spot on tx, since then has improved. Last couple of days become lethargic, slower on his walks, not eaten bfast last night. No V/D. Clingy at home. Yelping occ when lying down for no obvious reason. No known trauma. No stools today. QARCVS - HR 88, pulses fine, mm pm crt1sec g2 dental diseaseresp - nad abdo palp - nad neuro exam WNL no ticks found t - 38.1 CERVICAL pain - on flexion to LHS and RHS repeatable, no spinal pain elsewhere ddx - cervical pain - IVDD vs bony vs soft tissue, MUA (less likely due to normothermic but cannot r/o at this stage), other inflammatory, tumourtx - rec Ais, paracetamol and gabapentin and STRICT rest the next 7 dyas. Offered bloods and imaging but O decl, O is aware needs this done if issue repeats or if no improvement 

Examination Text:Reason: Lump CheckAppointment Notes: Been around for a while, now possibly bigger and irritating PtRSBHistory: has lump under ths skin on RHSOnly noticed the lump 2 days agoNot changed in that time, but now seems more tender.No trauma or anything noted to cause it.Otherwsie well in himselfExamine: BARAll vitals normalTemp = 38.5Lump on RHS of chest towards last rib area, and closeer to spine than sternumLump is ill defined approx 3 x 3 cm with discharghing sinus in the cventreLump is s/c in natuer but attached to deeper layers of demrisIs a bit red and sl buried as wellCan express some purulent material with abit of blood and is sore for the dogLaboratory: cyto shows mostly nurtrophilic inflammation with ++ intracellular cocci, some RBC'sAssessment: abscess with some surrounding cellulitisIs drasining a small amountCat bite vs FB vs other such as infected tumour/cystTreatment: LA block tpically, able to widen draining hole by sticking end of syringe in there and flushing with saline - flucing clear by the endHome with clav and NSAID'sAnd O to squeeze and use topical chlorhex 2-4 times dailyPlan: rechcek 2 weeks or earlier if worsens or lump movingMay need surgical exploration

Examination Text:Reason: Scratching / Not EatingAppointment Notes: Paws App Details:Os daughter brought in. Reports for the last week or so been itchy around backend, scratching and nibbling and has a couple of scabs. Treated recently with simparica trio. Always been a fussy eater but eating a bit less atm O thinks due to itching. No V/D, otherwise well. BAR Skin - erythema generally but mainly over lumbar area. Couple small scabs. No flea dirt in coat or other lesions. Teeth - g3 dental disease, slab fracture to 108 as per prev.Rest PE WNL Ddx - dental disease + #108, skin allergies vs flea allergyTx - adv steroid course for current pruritus. Keep UTD with simparica trio for tick/flea and heartworm. Adv overdue for vaccines - daughter would need to tell and ask parents before making decision so decl today. Also rec dental at least stage 2 to assess 108 also