C09974212 / invoice 10000

Last 48 hours noted big improvementoozing from abscess reduced and stopped after 48hoursfinished ABs yesterdayhad dose of meloxicam yesterdayfinished panadolBack to 95% of energy levelsEDDU WNLno licking in the area but some occasional spinning around and 'looking' at his tail baseBAR, mm pink, CRT<2sec, oral exam NADeyes and ears WNLdental health goodLN WNLheart auscultation NAD, HR 80bpmlung sounds clearabdominal palpation NADRHS caudal thigh still some mild swelling present. no pain on palpation, draining tract has healedtemp 38.5rectal exam - LHS WNLRHS - whole area is inflammed, thickened and firm. Painful when palpating this area. Unable to palpate AG in this area - as the general area is all firm and uniform.Assessment- Significant improvement since presentation last week. Normothermic, no longer purulent discharge and swelling reduced. Behaviour and energy levels are also almost back to normal. Based on palpation of the area suspect still has a/g and surrounding tissue inflammation/infection (cellulitis). At this stage, GA and a/g flush not likely to be hugely informative. Will proceed with additional Amoxyclav course for further 10 days then recheck.Plan - to continue further 7 days of ABs and NSAIDs then recheck*owner moving to melbourne in approx 2/3 weeks. Revisit will likely be our last consult with them. Need to forward history to new vet in melbourne.

Yesterday Parker noted to be very flat and seemed painful/sensitivewas taken to VSOS yesterday eveningBloods/U/s and PE suspect abscess on RHL, possible A/G abcess and secondary celluitisSent home with NSAIDs (meloxicam) + AntibioticsAbscess ruptured shortly after dischargeQAR, mm pink, pantingHR 120bpmopen wound noted RHL caudal thigh, consistent with AG abscess locationLarge volume of puluent and blood dischargevery painful in the areaattempted to flush and palpate area but too painfulPlan:Home with meloxicam and antibiotics as dispensed by VSOSINI recheck 24/48 hours with likely sedate and flushOtherwise recheck for anal gland exam/rectal exam next week

History:- Presented for a skin issue/lamenss on the R fore, which is suspected to be a hot spot. The owner reports the dog was scrambling all day yesterday and may have fallen up the stairs. Allergies are considered a contributing factor, as the skin is currently sensitive.- Will walk normally but doesnt want to put full weight on his foot- been licking at it for 2 days- No known trauma, normal day yesterday- Not on any medication, may use a zrytec but not consistently- On meals for mutts diet- Nose lesion looked better on antibiotics but started to come back abit once stoppedPast Medical History:- History of allergies, with previous episodes of skin issues on the nose that resolve for a period before recurring every couple of weeks.Physical Examination:- Examination of the R fore reveals a sore interdigital space on his R foot. The dog is walking with a limp intermittently, suggesting pain on weight-bearing. There is no swelling or other signs of musculoskeletal injury. Good range of motion in carpus, elbow and shoulder. Dog will walk normally.- R fore interdigital skin is moist and is very irritated by it.- Nose lesion has 80% healed, small excoriation and raw section but looks ok- Small dry scab on dorsum of back, healing but is bothered by itAssessment & Plan:1. Hot spot on foot (Interdigital space)- Impression: Hot spot (acute moist dermatitis) with secondary bacterial infection.- Treatment planned:- Wash + neocort cream: Apply to the affected area for 10-15 minutes before rinsing. Advised to prevent licking to ensure efficacy.- Antibiotics: A two-week course of a different antibiotic to the one previously used. One and a half tablets to be given with food.- Steroids: A tapering course of steroids to reduce inflammation and irritation. Start with one whole tablet once daily for five days, then reduce to half a tablet once daily for four days, then half a tablet every second day. Advised to monitor for side effects such as increased hunger, thirst, or urination.- Antihistamines: Can use as needed for allergies. Counselled on the safety and efficacy of daily use if it proves effective in managing symptoms.- Clinician's recommendations, education and counselling: Advised to keep the area dry and allow for air circulation. Discussed that skin issues often require longer treatment courses. If the area improves significantly, the steroid course can be tapered earlier.- Will also see how goes with nose with antibiotics for a longer course.Key Takeaways:- Administer antibiotics and steroids as prescribed, following the tapering schedule for the steroids.- Use the Malaseb wash on the affected area for 10-15 minutes, ensuring the dog does not lick it off.- Continue Zyrtec for allergies as needed.Next Steps:- Monitor the skin lesion for improvement. The antibiotics will take approximately 48 hours to start working.- If the skin is not improving by early next week, or if the dog is still limping, a re-check is recommended.- If the skin clears up, the steroid course can be tapered earlier.