C09979624 / invoice 20000

Appointment Notes: Hendrix (Dog) - Consultation (illness, check-up etc) [Veterinarian : Dr. Justina Han(No Preference)] - Sore back leg, limping when getting up. Unsure what happened. No real indication from him as to where it is soreWeb BookingClient name: Lucy connContact number: 0438660778Email address: lu2228@proton.mePatient name: Hendrix Original Appointment Type: Consultation (illness, check-up etc)????HISTORY:Presents for left hindlimb lameness.Lameness present for two weeks, progressively worsening in the last few days.Worse after periods of rest. Not consistently weight bearing.Owner noted leg shaking yesterday morning.More clingy and inactive than usual.EDDU normally.Previous history of self-resolving right forelimb lameness following dental. Resolved spontaneously. Diet - Leaps and Bounds dry food with water and vegetable scraps. Appetite normal.Prevention - UTD Bravecto.Meds - Trazodone - 100 mg - one tablet approx 8amEXAMINATION:Anxious and stressed, T-not taken to limit stress, HR100, RRpant, BCS 7/9Oral: mm PM, CRT <2s. C0G0 of visible teeth but limited exam due to head shyness.Eyes: NAD.Ears: NAD.Nose: NAD.LN's: no lymphadenomegaly of peripheral LNsInteg: NAD.Neuro: NAD, full exam not performedMSK: toe touching LPL lameness. Swelling and pain on palpation of D2. No crepitus or obvious luxation palpable, no superficial lesions. Pseudopads noted of D2 and 5. No stifle effusion, possibly reduced hip extension bilaterally but very tense on exam. Rest of exam unremarkable. Resp: normal BV sounds, normal respiratory effortCVS: no murmurs, normal rhythm, intensity, SSFPAbdo: soft and comfortable, no organomegaly palpable.Urogen: NAD.PROBLEMS:Progressive LPL lameness of 2 weeks duration - LPL D2 swelling/pain on examASSESSMENT:Differentials include soft tissue injury, fracture, luxation, osteomyelitis or neoplasia.TREATMENT:COMMUNICATION:Discussed diagnostic plan including sedation and radiographs.Provided cost estimate.Discussed differential diagnoses for lameness and toe swelling.Advanced imaging (CT scan) was discussed as potential sequale if no obvious signs visible on x-ray and no improvement on medication/rest.Owner declined optional pre-anaesthetic blood work.Consent for sedation, radiography and CPR obtained.?????    Vital Signs    Weight: 39.1;       MMColour: Pink;       HeartRate: 100;       CRT: 1-2;       

Additional Gabapentin 300mg PO on admission as quite nervous. Ate this easily in some spray treat.Would not allow IV catheter placement. Premed medetomidine 5mcg/kg (0.2ml) and methadone 0.2mg/kg (0.78ml) IM. Still nervous but IV catheter placed.  Alfaxan IV to effect. Lateral and DV view of LH foot. Soft tissue swelling of D2 presentNo fracture, instability, crepitus visible/palpable. Clipped toe. Bruised flocculent swelling present on medial aspect of PIII. FNA performed. Small amt (0.1ml?) of serous fluid. Cytology: 95% Seg neutrophils, RBC and other WBC represented in small %Clipped nails. Nail of D2 was fragmented on the medial aspect but quik not involved. Atipamazole 0.2ml sc. Meloxicam 1.56ml sc at 3.40pmAmoxyclav 500mg PO at 3.40pm with some more foodTGH w:-Amoxyclav 600mg x9. 1 tab BID. Start trow morning-Meloxicam 32ml. SID dosing for 35kg for 6 days starting trow evening-Confine as much as poss-RV w JH orJS in 1 wk (when off abs for 48hrs). Discussed if swelling still present/recurs then would either recom, exploratory or CT scan to chk for potential FB/pathology etc      Vital Signs