C09986390 / invoice 10000

Reason - grass seed removal pawSubjective:HR - 116RR - 28Temp -  not takenCRT  - pink, moist, CRT <2sNails - trimmedEars - clean, hairyTeeth - G4ASA - 2Laboratory:PAS declinedObjective:Premed - 0.38mls methadone (10mg/ml) + 0.01mls medetomidine (1mg/ml) IV @ 11:59amInduction - 1.5mls alfaxalone (10mg/ml) IV @ 12:12pmIntubated with 7.0mm cuffed ET tube and maintained on 2-2.5% isoflurane delivered through a rebreathing circuit in 0.8L/minute fresh flow O2Surgery:Start time - 12:12pm (probing), 12:27am (incision)Procedure - Initial probe of drainage tract with alligator forceps, no FB located. Feels like only SC pocket ~1cm in diameter, no tracts located.Prepped for surgical incision, incision made over focal swelling ~1cm in length. Pocket thoroughly explored without FB located. Tract located angled proximally ~2-3 inches followed. No FB located still.Closed SC with 2-0 silverglide PGCL in a simple continuous pattern.Closed skin with 2-0 silverglide PGCL in 2x interupted cruciates.Bandage:Dressed with allevyn, cotton balls between all toes. Softbann primary layer, elastoplast secondary layer with fixomull layer between elastoplast and skin (otherwise would expect painful to remove elastoplast if in contact with his hair type).Surgery finish time: 12:37 (12:44 bandage)Anaesthetic finish time: 12:45pm.Recovery - EXTREME panic immediately on recovery, screaming, thrashing and wildly attempting to bite. Calmed down after ~2 minutes of holding in a towel. Unable to administer sedation during this time due to safety risk.Medication - 0.25mls meloxicam (5mg/ml) SC @ 12:46pmHome with 12kg dose meloxicam PO SID (Os have at home)Plan:Recheck bandage change/removal in 3-5 days (earlier if slipping)Monitor for grass seed migration out of skin vs if further pocketing developing, consider repeat surgical exploration through this.    Vital Signs    

Appointment Notes: sore paw —Subjective:Presented for his paw being no betterLicking excessively. New swelling has appeared on dorsal surfaceDUDE normal, no concernsTaking meloxicam ok. Not had any today No other medications—Objective: BAR. good boy. HR/PR/CV: 132, no murmur, matching MM/CRT/Hydration: pink moist, <2, adequate RESP/RR: no wheezing or cracklesGIT/UG: abdominal palpation comfortable and unremarkable Skin/Ears: LFL dorsal raised swelling ~3cm round in interdigital space between D2-3. Ventral surface NAD. Explored area but very sore and reactive to forceps. M/S:  No lameness. Eyes: NAD Dental: G2 Lymph Nodes: WNLBCS: 5/9—Assessment:Possible g/s in paw —Plan:Admit for g/s explore under GA. Discussed risks of GA.  ________________________INSURANCE HXInitial Assessment > sore paw Suspected cause > g/s vs other Date of first clinical signs >4/3/26Any other conditions / treatments > no     Vital Signs    Weight: 12.9;