C09999698 / invoice 10000

REASON: Acute onset of left forelimb lameness and distress.HISTORY:- Presented for acute onset of distress and non-weight bearing lameness of a left hind leg during a walk this evening.- The incident occurred suddenly on a dry grass patch after crossing a paved area.- Bella suddenly lifted her leg, vocalised, and began insistently licking the paw, with the leg observed to be shaking.- She was very distressed and has remained bothered by the paw since the incident.- The owners attempted to inspect the paw but could not identify any foreign body or source of pain.- There has been no vomiting or diarrhoea.- Pre-existing conditions: A history of recurrent ear infections secondary to suspected allergies, which are currently managed and well-controlled.- Access to toxins: There was an area with broken glass at the beginning of the walk, approximately five minutes before the incident occurred. Otherwise, no known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavenged.- Current vaccination status: Up to date.- Current medications: Steroid ear drops administered twice weekly for management of ear infections.TRIAGE:- HR 132-Pink MM- CRT 2s- Temp: 38.9°C- Mentation: QAREXAMINATION:Body Condition Score:5/9Pain Scale (0-4):0.25Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous.Respiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge.Neurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performed.Musculoskeletal: Marked discomfort and irritation localised to left hindlimb. Palpation of the limb did not elicit a pain response in a specific area, but there is significant licking and biting directed at the paw. Redness was noted on the central paw pad, with a possible pin-prick mark suggestive of an insect bite.Gastrointestinal:- Oral: NSF- Abdominal: Soft and non-painful on palpation.- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: Left hind limb marked interdigital erythema, pin prick mark (suspect insect bite). No obvious foreign body, trauma or otherLymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS:Nil performed.PROBLEM LIST:1. Acute paw irritation and pain.2. Moderate localised allergic reaction.DIFFERENTIAL DIAGNOSIS:- Insect bite (e.g., ant, bee): High suspicion due to the acute onset, intense localised irritation, and inflammatory signs on the paw pad.- Foreign body penetration (e.g., grass seed, glass shard): Possible, given the history of walking past glass. However, no visible trauma or bleeding was noted on initial examination.- Soft tissue trauma (sprain/strain): Less likely given the intense licking and biting behaviour without a clear focal point of pain on palpation.ASSESSMENT:Bella presented for an acute onset of severe irritation and lameness in the left hind limb that began suddenly during a walk. Examination revealed significant inflammation and redness on a central paw pad, highly suspicious of an insect bite or similar acute allergic reaction. While a penetrating foreign body like a small piece of glass cannot be completely ruled out, the clinical signs are more consistent with a hypersensitivity reaction.Upon presentation, an antihistamine injection was administered. After approximately 10 minutes, there was only a minor (estimated 10%) improvement in her level of irritation, and she continued to incessantly lick and bite at the affected area. Given the persistent and significant level of discomfort despite the antihistamine, a more severe localised inflammatory reaction is suspected. It was discussed with the owners that adding an anti-inflammatory medication is warranted to manage the pain and inflammation more effectively. The plan is to administer a one-off steroid injection. The importance of preventing self-trauma through licking was also discussed, with the potential need for an Elizabethan collar.The owners were counselled that if the signs do not improve or worsen over the weekend, further investigation would be required. This could include sedation to allow for a more thorough examination of the paw, including clipping the fur and exploring the area for a deep or microscopic foreign body. Radiographs would be a consideration if a metallic or other radiopaque foreign body was suspected. At present, the working diagnosis is a moderate localised allergic reaction.TREATMENT:-Niramine 0.5ml SC- Dexamethasone injection 0.1mg/kg SC administered during consultation.PLAN:- Discharge home for monitoring. Owners are to prevent licking of the affected paw, potentially using an Elizabethan collar if necessary, to avoid secondary skin infection or trauma.- Monitor for resolution of lameness and irritation. The steroid injection may take approximately one hour to take full effect.- If Bella continues to be significantly bothered, if the lameness does not improve, or if any new signs such as swelling, discharge, vomiting, or breathing difficulties develop, she should be re-presented for further evaluation. Follow-up may involve sedation for a more detailed paw examination and/or radiographs.DISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Diagnosis: Suspect Hypersensitivity/Allergic ReactionHypersensitivity reactions:Hypersensitivity reactions can vary from facial swelling and raised lumps over the body to severe anaphylaxis causing vomiting, collapse and respiratory difficulty.  Generally the cause of the reaction is unknown but it is most commonly thought to be caused by insect bites or possibly contact with plants.  Facial swelling and skin lumps is the most common form, this is usually managed with anti-histamines in combination sometimes with an anti-inflammatory. Monitoring at home: The swellings should reduce gradually over the next 12 hours, occasionally they can persist for longer and a longer course of anti-histamines and anti-inflammatories are required.  Your pet will need to be reassessed by your primary care veterinarian and they will determine if that is suitableThe anti-histamines can make your pet sleepy over the next 12 hours.Please keep your pet rested until the skin lumps have completely resolved then gradually reintroduce normal activity over the following week.They are fine to be offered food and water as per normalMedications given:Anti- histamine injectionDexamethasone injetion - anti-inflammatory injectionRecheck:Once you pet is discharged home we advise a reassessment with your primary care veterinarian within 48 hours to monitor your pets progress.If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. If your pet's condition deteriorates or fails to resolve over the next 24 hours, or they become flat or lethargic, go off their food and water, develop vomiting or diarrhoea, develop breathing difficulty or if you have any concerns please contact our team or your primary care veterinarian immediately. Thank you for trusting us with the care of your pet.    Vital Signs    Weight: 7.7;