C09998838 / invoice 10000

Reason: Increased Thirst Appointment Notes: kjbHistory: Went to Palmyra and was treated with antibiotics for a torn nail a while ago Seemed to do alright but developed swelling and irritation in one of his paw pads - went back to Palmyra and was treated with antibiotics and prednisoloneFinished all medications 2 weeks ago Polydipsia started at same time as steroids but has persisted despite stopping them a while ago Water bowl is about 600ml - drinking several bowls per day initially, today seems to have drunk lessOtherwise very well Current Medication: none Examination: Demeanour: BAR, loves treats BCS: 4/5HR/PR: 100. No murmur or arrhythmia, pulses strong and synchronous RR/Chest: panting. Normal effort and BV sounds MM/CRT: pink, moist/1.5Oral/Teeth/Gums: stage 2 dental disease Temp: not taken Ears: external pinna clean Eyes: nad LNs: SM, PS, P wnl Abdo/GIT: soft and comfortable, subjectively looks a little pot-bellied U/G: not assessed M/Skel: R carpal valgus, ambulating well Neuro: mentation appropriate, no obvious deficits Derm:- focal, poorly-circumscribed, floculant swelling approximately 1.5cm diameter along dorsal surface of RF paw between digits 2 and 3. Very sensitive to palpation - licking this area a lot - focal raised, pink, unhaired lumps along other feet - did not examine these closely Problem List:1. PolydipsiaA: would be a side effect of prednisolone, though unusual it has persisted 2 weeks after this has finished. Discussed other causes include Cushing's, renal disease, DM etc. Recommend getting bloods done as first step - O familiar with Cushing's as sister's dog has it and have explained we will not be able to definitively diagnose this based on general bloods alone, but should expect some characteristic changes that may raise our suspicion of it.P: await CWP results2. RF paw lump A: looks very inflamed - given appearance and degree of irritation would be concerned for possible FB penetration however O says it has been present for years and been explored/lanced previously. Unusual it has persisted despite oral steroid and antibiotic treatment recently. Can try managing with topical steroids for now (O has Elocon at home)    Vital Signs    Weight: 17;