C09990662 / invoice 10000

Reason: Re-Check Foot Appointment Notes: req PMCO req move from 2/3History:- Left foreleg issue ongoing- Previous treatments included Antibiotics and Meloxicam- Improvement noted over the weekend after treatment but still limping- Concerns about Carpus area and potential sprainExamination:Left foreleg: Limping observedDigit 2: Edge of the pad removed, callous area noted, part of the pad missingDigit area: Hyperkeratosis notedGeneral: No swelling currently observed in the digitsDIAGNOSIS- Possible soft tissue injury or strain in left foreleg- Abrasion and missing pad on digit 2 possibly due to friction or injuryPlan:- Discontinue previous anti-inflammatory due to incorrect dosage and potential side effects- Start Carprofen, once daily with food, for pain and inflammation- Monitor and avoid rough surfaces to allow pad healing- Consider imaging (X-ray or CT) if no improvement or if condition worsens- Recheck in 3 weeks or sooner if symptoms worsen    Vital Signs    Weight: 9.1;       

--- 21/02/2026 14:48:56 SMW:O's called after sending through consent formAdvised they don't want the digit amputated during the procedure on monday and would prefer a biopsy and await results to ensure amputation is necessary. Is happy for vet to call O while under GA if they want to discuss amputation more and thinks they need it    Vital Signs    Weight: 9.2;       

Reason: Sore Foot RecheckAppointment Notes: req CLB may cancel if improvmentVerified: NoCLB - 20/02/2026History:  Presenting for: Lily, a dog, presented for a sore digit on the left foreleg with a lump and intermittent weight-bearing.  Historical Conditions:  - Cushing's disease, well-controlled  - Previous surgery in December for an abscess on the chest  Diet:  - No changes reported  Drinking/Urination:  - No changes reported  V/D/C/S:  - No vomiting, diarrhoea, coughing, or sneezing reported  Skin:  - Lump on the left foreleg digit  Current Meds:  - Antibiotics (name not specified)  - Meloxicam (pain killer)  - O has NOT been giving- Trilostane for Cushing's disease  Lifestyle Risk Factors:  - Not specified  Other:  - Client concerned about the possibility of melanoma  Examination:  Mentation: BAR  Behavioural: FAS score 3/5, anxious and barking throughout the consult  Integumentary:  - Swelling on digit 3 of the left foreleg, particularly on the medial aspect, with hyperkeratosis and erythema  - Painful on examination  Musculoskeletal:  - Intermittent weight-bearing on the affected limb  - Holding the limb up at times  Assessment:  Swollen digit on left foreleg - DDx: Foreign body, infection, neoplasia, traumaPlan:  Diagnostics:  - X-rays of the affected digit to assess bone involvement  - Potential biopsy of the swollen area if indicated by X-ray findings  - Discussed the possibility of digit amputation if there is significant bony involvement or if biopsy results indicate malignancy  Medications/Treatments:  - Continue antibiotics as prescribed  - Continue Meloxicam for pain and inflammation management  Additional Discussion:  - Discussed the risks and benefits of biopsy versus amputation, including the possibility of a second surgery if biopsy results indicate malignancy  Client Comms:  - Discussed the importance of continuing current medications and monitoring Lily's condition over the weekend  - Advised to bring Lily in on Monday morning without breakfast for further assessment and potential procedures  - Provided an estimate for potential costs, including the possibility of digit amputation and pathology lab fees for biopsy analysis    Vital Signs    Weight: 9.2;