C09996651 / invoice 10000

Hx has a swollen fourth digit of the left hind foot. On clavulox 250mg PO BID, paracetamol 250mg PO BID and meloxicam 0.1mg/kg PO SID since last night. In for x rays of the toe to day to rule out fracture.Exam: bAR, mm pink, mm pink, euhydrated, ascultation heart and lung sounds normal, vitals wnl, ambulatory but holding the left hindleg up - the fourth digit of the left hind foot is swollen, inflamed with no open wound noted.Diagnostics: x rays - DV and lateral views of the left hind foot - no changes in the bone, small lucency in the medial tissue but no FB noted.Assessment: likely soft tissue injury that got infection (possible penentrating wound before)Treatment- continue clavulox 250mg PO BID- meloxicam 0.1mg/kg PO SID for 7 days- paracetamol 250mg PO BIDPlan: recheck in 7 days

HistoryNoticed a slight limp since Sat am (2 days ago), noticed toe swollen yesterday, much more swollen today, not weight-bearing on it at all - hind left ;eg.Gave meloxicam sat and yesterday, none today.EDUD normal.Subjective:Swollen toe on back left legFirst noticed few days ago, getting worseNo known trauma. Lives near river, runs with other dogs chasing ducks and lizardsVery sore, walking on three legs, getting tiredHad tick under chin ~3 weeks ago, removed immediatelyPast Medical History:Weight: 11.6kg (17/03/2025)Previous health check earlier this year - all normalPrevious desex surgery - recovered wellObjective:Left hind leg affected - middle toes swollen and red both sides, predominately affecting digit 4Grafts and debris noted next to nail - pulled these out during consult, no exudateAttempted examination - very painful and resistant to manipulationSmall amount of material removed - possibly frayed nailNormal thoracic auscultationRest of exam unremarkableAssessment & Plan:1. Swollen toeDdx foreign body abscess, trauma/fracture, neoplasia, otherInvestigations: X-rays planned under anaesthetic tomorrowTreatment:- Amoxiclav 250mg 1 tablet BD with food x 10 days- Continue Meloxicam: 250mg tonight morning- Paracetomol 250mg PO BID - tonight and tomorrow morning- Surgical exploration likely needed - estimate $820-1000- Fasting instructions given for tomorrow's procedurePlease advise on admission what medications have been givenAssessmentL HL Digit 4 - pain and swelling Ddx infection, foreign body, trauma/fracture, neoplasiaTreatmentClav 200mg PO BIDMeloxicamParacetomolClient communicationSedation/GA for radiographs and possible surgiocal exploration of LHL digit 4Estimate GA $220, radiographs $300, surgery $200, other $100 = $820-$1100Has Pet InsurancePlanBooked procedure for tomorrowPlease advise on admission what medications have been given

Procedure: SpeyPre-anaesthetic exam:Weight: 10.9kgVitals WNL, BAR, normal mentation. mm pink and moist, CRT 1-2 sec, no murmurs or arrythmias on cardiac auscultation, lung fields clear, LN normal size and consistency. Abdomen is soft and comfortable, skin and coat normal.Pre-medication: 0.3ml Methadone IV + 0.05ml Domitor IV + Cerenia 1ml SC interscpaularCatheter: 22G catheter into cephalic veinInduction: Propofol 5mg/kg IV used to effectMaintenance: IsofluraneET tube size: 6.5Monitoring: HR, RR, SPO2, ETCO2, temperatureIVF: Hartmann's fluid at surgical rate (10mls/kg/hr)Heating: heat matProcedure: Shaved and prepared vetnral abdomen a few centimetres cranial to the umbilicus to the pubis for surgery with iodine scrub. A midline incision extending 7-12cm from the point just cranial to the umbilicus was made through the skin and subcutaneous tissue with a scalpel blade down to the linea alba. A stab incison was made through the linea alba and the incision extended to expose the abdominal cavity. The suspensory ligament of the ovary was manually stretched to exteriorise the ovary. A 2 clamp technique and 0 filaxyn was used to ligate the ovarian vessels proximal to the ovary, followed by transection of the ovarian pedicle distal to the ligation. The stump was observed for bleeding and returned into the abodmen and repeated on the other side. 2 separate, single, transfixation ligatures were placed to ligate the uteirne vessels at the body of the uterus using 0 filaxyn. Using the same suture, a cicumferential ligature was placed around the uterine body and the uterus transected proximal to the ligature. The uterine stump was observed for bleeding and returned to the abdomen. The abdominal wall was closed using 0 filaxyn in a simple continuous pattern and some bupivicaine splashed on the surgical site. This was followed by closure of the subcutaneous layer with 2-0 filapron in a simple continuous pattern and intradermal sutures.Recovery: smooth recoveryPost-op medications:- Meloxicam 0.2mg/kg SCTake home medications:- Meloxicam 0.1mg/kg SID PO for 3 days.