C09981198 / invoice 10000

toe infection back 
lump in neck

Subjective:
- Toe infection and lump on neck
- Concurrent CKD.
- Left hindlimbsecond digit: nail cut just before Christmas, became infected, nail removed at emergency vet on Saturday before Christmas, now swollen again
- Neck lump: noticed yesterday, large.
- Owner has been giving meloxicam for past couple of days
- Vision significantly declined, smell intact
- Eating and drinking well
- Sleeping approximately 23 hours per day


Exam:
BAR
LHS prescap region is a 8-9cm raised firm subcut lump
HR: 130
Temp: 37.9
Left hindlimb 2nd digit swollen: nail absent with small area of granulation tissue?
Left popliteal lymph node enlarged
Attempted FNA of lump: Non-diagnostic
MM:pm crt 2s
Abdominal palp:nad
Bilateral hindlimb muscle wastage

Problem list
1. Left prescap lump
2. Left hindlimb digit 2 swelling
3. Popliteal Lymph node enlargement
Ddx:
1. Benign vs malignant neoplasm
2+3. Benign vs malignant neoplasm vs infection: Lymphadenopathy likely related to digit 2 swelling.

Tx:
1,2,3: Reccomended refferal to specialist for assessment of above problems. In the meantime have dispensed amoxyclav and asked owner to stop giving meloxicam and give 300mg gabapentin BID.

Plan: RV if getting worse.