C09996296 / invoice 10000

Reason: Wound On Paw. Was Seen For It previsouslyAppointment Notes: Apoquel script too pls CB dr summer pls. Offered appt tomorrow but o declined till friday due to work JH  ------- Sms reply: YHistory:HISTORY:  Recheck consultation for a persistent cut on the left front paw. The owner reports a flare-up of skin issues last week which has since improved. There is a new lump between the third and fourth digits of the left front paw. The owner is also due to see Dr. Kin on 11/03/2026 for a fine needle aspirate of other masses.From previous consultation on 26/02/2026: Presented for itchy parapreputial region and front feet, a cut on the right front foot, and a check of two masses (one on the right forelimb, one on the right lateral stifle). History of atopic and food-allergic dermatitis, well-controlled on long-term Apoquel. Skin flare-ups are common and typically respond to medical management. Requires a chill protocol for veterinary visits. Examination revealed papules on the right parapreputial region, interdigital erythema, a healing cut on the right front foot, and two dermal/subcutaneous masses. Skin cytology was negative. Assessed as inflammatory dermatitis flare-up.Current meds: Apoquel 16mg PO BID for the last 9 days (one week of BID dosing remaining), Neocort cream topically to inflamed areas.Vaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: Atopic and food allergic dermatitis.Access to toxins eg. Rodenticide: noneTRIAGE:Demeanour/Behaviour: not discussedEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory:thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological:neurologically no significant findingsMusculoskeletal: A lump is present in the interdigital space between the third and fourth digits of the left front paw.Gastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):not graded- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: 0.8cm Cut on the left front paw palmar side between 3rd and 4th toe. A lump (2x lumps very close to each other) is present in the interdigital space between the third and fourth digits of the left front paw. no obvious open wound on skin Lymph Nodes: NSFEyes: NSFDemeanour/Behaviour: not discussedPROBLEM LIST:- Interdigital lump, left forelimb (new finding)- Cut on left front paw- Atopic dermatitis flare-up- 2x lumps (one on the right forelimb, one on the right lateral stifle) due FNA next wed with dr kin DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:For the interdigital lump: Foreign body (e.g., grass seed, though considered less likely), deep skin infection/abscess, neoplasia.DIAGNOSTICS:NoneASSESSMENT:Wicket presented for re-evaluation of a persistent cut on the left forelimb. A new interdigital lump has been identified on the same paw. The skin flare-up appears to be improving with the increased Apoquel dosage. The interdigital lump requires further investigation to rule out differentials including foreign body, infection, or neoplasia. A fine needle aspirate was offered but deferred to the appointment on Wednesday with Dr. Kin. Blood tests for monitoring chronic Apoquel use are recommended every 6 months and are now due, but the owner declined today.TREATMENT:  - Apoquel 16mg, 50 tablets dispensed. Continue one tablet PO BID for one more week, then reduce to one tablet PO SID for long-term maintenance.- Cephalexin 1 and 1/4 tablets PO BID with food. Dispensed today. 22mg/kg- Continue applying Neocort cream topically.- Strict rest, no walks, to allow the paw to heal.- Clean the cut on the paw twice daily with diluted Betadine solution, pat dry, then apply Neocort cream.PLAN:Home into owner's care.Recheck with Dr. Kin on Wednesday (08/03/2026) for previously scheduled fine needle aspirates of other masses. The new interdigital lump can also be assessed and sampled at this appointment.Monitor the lump for any change in size. If it reduces, this is a positive sign. If it remains the same size or worsens, further diagnostics such as surgical exploration under general anaesthesia may be required.Recommend blood tests for chronic medication monitoring at a future visit.CLIENT COMMUNICATION:Discussed the new lump on the paw and the differential diagnoses, including the possibility of a foreign body, infection, or cancer. Explained that a definitive diagnosis cannot be made by visual inspection alone and that a fine needle aspirate is recommended.Advised on wound care: purchase Betadine liquid from a human pharmacy, dilute to a weak tea colour, clean the paw twice daily wearing gloves, pat dry, and apply Neocort cream. Advised against using Betadine cream.Dispensed oral antibiotics (Cephalexin) and advised the owner to monitor for potential side effects such as vomiting, diarrhoea, or reduced appetite.Dispensed a one-month supply of Apoquel. Instructed the owner on the dosing schedule: continue twice daily for one more week, then reduce to once daily for long-term use.Advised strict rest and no walks to prevent aggravation of the paw injury.Discussed the plan to proceed with the fine needle aspirate of the lump on Wednesday. Advised that if surgical exploration is required for a suspected foreign body, this would incur additional costs and would require a general anaesthetic. The owner was informed that insurance should typically cover these investigations.    Vital Signs    Temperature: NT;       HeartRate: 110;       RespirationRate: pant ;