C09978364 / invoice 20000

Reason: Vomiting On Meloxicam (JHJ)Telephone Call: Vomited once this morning - bright yellow Mildly quiet Good appetite Normal stoolsCould be reaciton to the meloxicam - recommended switch to paracetmaol - dispensed owner will pick up. Let her know if GIT signs continue let us knowPassed over to Claire to make up meds and put in meds box AN    Vital Signs    

Reason: Sore Front Left PawAppointment Notes: saw Adam previously but the shampoo isnt working. Req GGKAHistory:Presenting for: Patient presented for evaluation of intermittent forelimb lameness and paw licking/chewing of approximately one week or more duration.Historical Conditions:- Previous shoulder dislocation(s) - client notes current lameness presentation is distinct from prior shoulder dislocation episodesDiet:- Inappetent this morning; refused foodSkin:- Paw licking ongoing for one week or more- Client reports intermittent lifting of a forelimb (initially thought to be right, now confirmed left) over the past week or more- Episode at park on Monday: patient suddenly lifted a forepaw and hobbled; client picked her up, checked the paw, put her down, and within 15 minutes the same thing recurredOther:- Patient was seen previously by Adam (likely a prior consult at this or another clinic) regarding the right forepaw; today the left forepaw is confirmed as the primary concern- Client reports patient has been digging at bedding/boards at night- This morning patient was reluctant to walk; when she did get up to access water, she lifted the affected paw throughoutExamination:Mentation: BART: Not TakenBehavioural: Friendly and social; readily solicited attention from the veterinary team. Notably improved in demeanour once in the clinic environment - less panting and less shaking compared to on arrival.Integumentary:- Left forepaw: erythema and soft tissue changes noted interdigitally, extending between digits 3 and 4; hair clipped/shaved to improve access and visualisation; area soaked and cleaned; one focal area of redness noted- Right forepaw: mild erythema noted interdigitally; nails trimmed- Tissue described as notably soft in the affected interdigital regionMusculoskeletal:- Intermittent left forelimb lameness confirmed; patient observed lifting left forepaw- No shoulder dislocation detected on examination- Right forelimb: mild interdigital changes noted but lameness less prominentAssessment:Interdigital erythema and pododermatitis, left forepaw (primary) and right forepaw (mild) - DDx: contact irritation/trauma (e.g. hot tiles, rough surfaces), self-trauma secondary to pruritus; chronology of whether licking preceded or caused the lesion is unclear. Lameness attributed to paw discomfort associated with interdigital lesions.Plan:Medications/Treatments:- 4Cyte Crane topical gel: apply to left forepaw BID for 5-7 days (until fully resolved); apply to right forepaw BID for approximately 2 days. Apply to finger and work in between all pads and digits. Apply while patient is occupied/walking to prevent immediate licking; distract for at least 15 minutes post-application.New Meds/Tx:- Meloxicam tablets (1 mg): cut into halves/quarters; administer orally once daily with a small amount of food for 5 days- Injection of pain relief administered in clinic today to provide immediate analgesiaAdditional Discussion:- Left forepaw hair clipped to improve topical medication penetration; right forepaw nails trimmed- Paw cleaning: warm water recommended as first-line; chlorhexidine (Chlorhex) or medicated shampoo (as supplied by Adam) may be used if paws appear soiled or festery, but warm water alone is preferred- Avoid salt water and sand (e.g. beach) - sand would be irritating to affected paws- If lesions cannot be controlled with current plan, wrapping or booties may be considered; however, vet is currently disinclined to wrap due to risk of reduced oxygenation, moisture accumulation, and worsening of lesions- Prognosis: vet expects significant improvement by the weekend; anticipates lesions will resolve without further interventionClient Comms:- Walks permitted on smooth surfaces only (pavement/footpath) for the next week - avoid grass, dirt, rough terrain, and sand- Fake grass at home is acceptable- Send photo or return for recheck in 5 days to assess progress- If licking of right paw does not resolve promptly with topical treatment, reassess- Contact clinic if condition worsens or does not improve as expected    Vital Signs    Weight: 3.1;