C09994597 / invoice 10000

History:LFL dew claw previousy injured Aug2024Last bloods done in 2023 - biochem wnlExamine:Demeanour: BAR - anxious  Integument: LF dew claw nail bent / growing in incorrect direction. RF dew claw nail very short Cardiovascular: HR , no murmur or arrhythmia ausculated Respiratory: RR , chest sounds clear no crackles or wheezesTemp: 37.4Treatment: sedation 50mg trazodone PO Drug 1: butorphanol 0.2mg/kg =  0.12   ml IVDrug 2:   medetomidine 0.005mg/kg  = 0.03 ml  IVResponse to sedation: mild Top up dom 0.02ml IVAlfax IV to effect Procedure:LFL dew claw clipped and cleaned with chlorhexidine solution Haemostats used to pull nail - removed cleanly to reveal small nail regrowing underneath. Trimmed as far as possible Area cleaned again w chlorhex Trimmed all nails short as possible  Plan:Meloxicam 0.5mg SID for 3 days Clean w chlorhexidine soln BID for 7 days to minimise risk of nail bed infection Advised keeping nails short to reduce risk of catching againDiscuss dental prophy at home + scale and polish q6-12mo    Vital Signs    

Reason: Injured Dew ClawAppointment Notes: EMReason:  consult  History: Carter Road Companion Animal Practice had a dental last year, think may have had bloods done (request hx before sedation).Diet: prime 100 roll + scratch kibble + mighty munchExamine: 1. BCS:   3  /52. Integument: : L dew claw fractured at nail bed. Also appears nail is growing backward/ been turned around? Sore on palpation. Dried blood at base of nail. No pus discharge. Barbering of hair on lateral flanks, no erythema.3. Musculoskeletal: G2 MLP bilateral4. Teeth: G2 5. Eyes: nad 6. Ears: nad 7. Lymph Nodes: nad 8. Cardiovascular/Circulatory:   nad  no murmur or arrhythmia9. Respiratory/Pulmonary:  nad 10. Uro-genital: nad 11. Gastrointestinal: nad ->11a Anal Sacs: not examined 12. Behaviour: BAR13. Other: Assessment: Fractured L dew clawMLP bilateralPossible allergic skin disease (environmental vs. Food) vs. EndocrineTreatment: Meloxicam 0.24mls SCPlan:Nail pull under sedation tomorrow. O declined PAS/CBC. Also to discuss allergic skin disease (antihistamines/cytopoint/topicals) and OA prevention for MLP (antinol/zydax) at discharge tomorrow.    Vital Signs    Weight: 6;