C09978792 / invoice 10000

Presenting Complaint:Hx: Panting, lethargy, discomfort, refused food today, Os took temp at home and was 39.5Felt lump on abdo that was hard -- where cystostomy sx site was (Oct 2025), few weeks ago had pencil sized hole at end of surgery site, Os checked at BVH and was ok. Known v high alp (in the 3000s), os think maybe Cushings but not had abdo imagingHas been drinking and urinating a lotHas oa, has been slowing down a lot, recently seemed to improve w meds, but last couple of days not wanting to walk at allHas had hx of prostatitis and was late castrate (~10y)Current Meds: cbd oil, meloxicam, clopidogrel (had prev thromboembolic event, went to waves)PE:        QAR, can walk but does not like floors here, needs non-slip mats down.     CVS: mms pink and moist, crt<2, pulses ok, HR 100    Resp: panting, bvs wnl    Abdo: Shaved central abdo area - in SQ/skin area is raised, purplish and hard. U/s over -- inflamed sq tissue, central hypoechoic (fluid) area w some floculant material, do not think communicates w abdo cavity. FNA -- seropurulent material drained; cytology shows +++++++neuts (mostly degenerate) w ++cocci.Difficult to palp as exmained in lateral or ventral recumbency. Distended abdo (overconditioned). Appeared non-painful other than around abscessed area.     MSK: known oa, not examined today.    Neuro: no decline in mentation, is alert and responsive, cns appear in tact (os not sure hearing so good anymore). Full np.    EENT: nad    LN: wnl     Skin: skin tent wnl.     UroGen: ne    Rectal: temp 39.2 Laboratory:BUN and CREA wnl. ALP wont read (suspect too high based on hx). ALT wnlUSG 1.010 CRP elevated 103.6 (>30 abnormal)WBC ^ 25.21 (4-14)Neut ^ 20.3 (2.3-9.8) - minimal bands on smearMonocytes elevated (3; 0-0.4) but dont think truly this high -- cbc machine has been making errorsProblem List: Abscess on abdomen over previous laparotomy (cystotomy) site -- suture acting for nidus of infection? Bacteraemia translocation? Vs prev penetrating injury (hole into area a few weeks ago)Suspected pyrexia -- elevated at home but just normal in clinic, is on melox, likely true pyrexiaIsosthenuria in absence of azotaemia V high ALP (wont read on machine, even diluted) - ALT and liver fn parameters okLack of stress hyperglycaemia despite aboveLeukocytosis with NeutrophiliaElevated crpTx/Plan:Discussed ideal C&S but by time sample gets to lab will not likely be helpful, decision to treat empirically. Mason not easiest to tablet, so enro as once daily. Given iv tonight, start oral mon pm. Liver fn parameters ok so adding paracetamol in, iv tonight, start oral tomorrow am.Os very worried about Mason, explained dont have option for 24/7 care so can take home and monitor, call if concerned; or leave in hospital w camera on, but will be periods where not supervised; or WAVES if they want him monitored overnight. Os do not want to go to WAVES, elected to tkae home, recheck here tomorrow midday to ensure Mason has improved then visit BVH Tuesday for reassessment and possible Sx (debride and explore abscess). Client Communications:Afterhours consultation for panting, lethargy, discomfort and abdominal lump.Mason has an abscess over his mid abdomen, in his subcutaneous space.Blood tests show signs consistent with marked inflammatory response. ALP (liver enzyme) would not read on bloods today.Urine is minimally concentrated which is likely related to his increased drinking, as his kidney parameters are normal on blood test.Enrofloxacin(antibiotic) and paracetamol given. Enrofloxacin(antibiotic) and paracetamol to go home.Recheck tomorrow at midday.Follow-up:TC - 2/3/26 - Craig called, Mason improved today, eating and temp down, want to cancel r/c and go bvh Tues. Talked Craig through IVC removal (as is not longstay catheter, needs to be removed).    Vital Signs    Weight: 47;