C09976102 / invoice 10000

REASON: Torn nail, right forelimb.HISTORY:Nau presented for an acute right forelimb lameness and a torn nail, which occurred today while running at the park.- Licking and biting at all four paws for the last couple of weeks, predominantly at night.- Intermittent lameness on a hindlimb also reported, side unspecified.- Appetite, water intake, urination, and defecation are normal.- No recent diet change, stressors, travel, or known toxin exposure reported.- Owner notes this paw licking behaviour may be seasonal and has occurred previously.OTHER:- Pre-existing conditions: None as reported from owner.- Current medication: None as reported from owner.- Access to toxins: No known access to any organic or inorganic toxins, foreign material, chemicals, nor snakes or venomous animals.OBJECTIVE:*Unable due to patient demeanor- Bodyweight: 37 kg- Body Condition Score: 3.5/5- Demeanour: Anxious, apprehensive with new people. Muzzled and lunging if I approach owner.- HR: Not assessed.- RR: Not assessed.- MM Colour: Not assessed.- CRT: Not assessed.- Temp: Not assessed.- Pain Scale (0–4): Not assessed.PHYSICAL EXAMINATION:Full physical examination was deferred due to patient anxiety. A torn nail on the right forelimb was grossly observed.PROBLEM LIST:1) Acute right forelimb lameness (mild, grade 1)2) Torn nail, right forelimb (P5)3) Chronic intermittent pododermatitis (licking/chewing all four paws)4) Hindlimb lameness, intermittent, side unspecifiedDIFFERENTIAL DIAGNOSTICS:- Traumatic nail bed injury +/- P5 fracture: Consistent with acute lameness after running and visible torn nail.- Allergic pododermatitis (atopy): Seasonal pattern of paw licking affecting all four paws is highly suggestive of an environmental allergy.- Food allergy: Less likely given the distribution of signs (paws), but cannot be ruled out.DIAGNOSTICS:Nil performed in this time frame.ASSESSMENT:Nau presented for an acute right forelimb lameness secondary to a torn nail. The history is consistent with traumatic avulsion. Given the mechanism of injury, an underlying fracture of the third phalanx is a possibility. The concurrent history of licking all four paws, particularly at night and with a possible seasonal flare-up, is highly suggestive of allergic skin disease, with environmental allergies (atopy) being the primary differential. The hindlimb lameness is a separate issue that requires further investigation. The patient's significant anxiety precluded a complete physical examination. Management of the torn nail will require sedation for proper cleaning, debridement, and thorough assessment. This will also provide an opportunity to perform a nail trim and examine the paws for evidence of pododermatitis. Due to the non-life-threatening nature of the condition and the significant cost difference associated with a public holiday, outpatient management was elected.TREATMENT:- Medications to go home:   - Meloxicam PO SID x 3 days (0.1 mg/kg)   - Amoxyclav PO BID x 3 days (15 mg/kg)   - Anxiolytic medication dispensed for use prior to veterinary appointments:       Gabapentin 600mg PO BID PRN       Trazodone 100mg (1 - 2 tablets) PO BIDPROCEDURES:Nil performed.PLAN:- Owner elected for outpatient management and declined sedation and immediate treatment today due to the increased costs on a public holiday.- Recommended follow-up with their primary care veterinarian on 03/03/2026 for sedation, assessment and treatment of the torn nail, nail trim, and investigation of pododermatitis.- Anxiolytic medication to be administered prior to the appointment tomorrow to reduce stress.- Long-term management strategies for nail care, such as desensitisation training or use of a scratching board, were discussed.- Otherwise, please refer to the discharge notes below for more in-depth information.    Vital Signs