C09973927 / invoice 10000

Appointment Notes: No improvement Hx: Wound/hotspot lesion on face seen 48hrs ago. Couldn't be examined properly on Saturday since so sore. Taking the NSAID fine as liquid, spitting out some antibiotic tablets so more challenging to give. Os describe wound as still bleeding - flecks of blood seen when applying cream or when she shakes head. Bonnie rubbing face after neocort applied. O consents to sedated exam today. Nice girl but face is so sensitive. Only eaten 2 pieces of chicken this morning with meds. Hospital: Sedated with 7ug/kg medetomidine + 0.2mg/kg methadone IM. Mild sedation but allowed IV cath. Induced deep sedation/light GA with propofol in gradual boluses.Clipped & cleaned skin under R ear & cheek with dilute chlorhexidine.Large hotspot - moist erythema, clumped fur, ulcerated skin. Applied small layer in-house neocort.  Very sore face. No ear infection. No other skin lesions. A: Hotspot on R neck Patient can't have pred or apoquel due to concurrent NSAIDs & previous MCT. Recc try neocort as primary anti-itch tx but is a challenge to apply. Discussed pros & cons with O - could consider stopping NSAID to start pred with omeprazole but only suggest this if Os feel the scratching has been uncontrollable. Plan: 1. Continue amoxyclav course to completion - watch for any spat out tablets & advise if not managing to give. 3. Apply neocort twice daily x 5 days or as needed if able to. Can wash skin with chlorhexidine & pat dry before each neocort application. 4. Continue meloxicam SID with food as needed next few days. 5. Recheck in 5-7 days.     Vital Signs    Weight: 34.2;       

LV JC NV11900 Presented for wound check History: - lastnight notice scratching at right cheek and found blood - eddu normal, no other changes - utd with vax and ftw - only pet at home - inside outside pet, occassional wildlife at home, didnt hear fight - frequent swimmer in home pool Exam: - mentation: bar, friendly but cautious, loves treats - vitals: hr and rr elevated but was a little stressed - nad gait and stance - bcs 3.5/5 - skin and coat: mostly ok: except for small wound on right cheek - very head shy will not stay still for exam - briefly palpated wound, no subcut abscess etc Assessment: - likley external trauma exacerbated by self scratching - wound examination not indepth due behaviour - discussed would like to clip and clean, o not keen treatment plan: - offered 1) meds and topical care 2) clip and clean under sedation - o opted for 1, advise if not better by wed, consider 2, o ok - 1) amoxyclav 500mg bid, metacam 2.3ml sid, neocort topical bid - advise with cleaning: warm salty water is fine but must dry after - warned of summer fly strike risks - take pics nightly, keep in touch, stay on meds, get a soft collar - if not better, return wednesday for recheck and possible GA clean thurs / fri wound on right cheek region - no swelling but some signs of light bleeding     Vital Signs    

owner got home & Bonnie has scratched at her face & had blood coming down side. Drove back. EE dispensed chlorhexidine solution for cleaning. Advised if no better to call Monday morning & will likely need sedation to examine further as too sore to touch currently.    Vital Signs