C10001024 / invoice 10000

skin

MM:
CRT:
HR:
RR:
TEMP: 38.4

Hx:



Pet Primary Diagnosis/Suspected Diagnosis/Location: Suspected Superficial Pyoderma
Suspect cause: Unknown at this time
Any other conditions being treated (if any): n/a
Known health concerns:  n/a
Date of first clinical signs (if known): Few months ago

Reason: Check LEFT hindlimb 

History: 
- Presented by owner Craig, who reports that Nandi was first noted to be lame on her LEFT hindimb ~ 5 days ago. Nandi had been taken to owner's farm during this time, no history of trauma and no other change to routine. Owner advised no possible access to rodenticide or any other toxin or medication. Nandi has not been tested for VWD, but BMBT previously performed a few years ago at a different vet clinic was reportedly normal. 
- She was taken to EVH on 06/10 and examining vet reportedly advised mild left stifle pain, but NSF on palpation of TPLO site. No further investigations reportedly performed, was prescribed firocoxib. EVH history not availble at the time of this consult. 
- Lameness improved and Nandi is now fully weightbearing. Within the past 24 hours however, she reportedly developed subcutaneous swelling in the region of her hock. No other concenrs noted.
- Has otherwise been healthy and well - eating, drinking, urinating and defecating normally, with normal appetite and energy level. 

Examination:
Mentation: BAR 
BCS: 3.5/5 - weightloss recommended 
MM: Pink
CRT: 2 sec

HR: 90
RR: panting
Temp: 38.2*C

Cardiorespiratory: Very challenging to auscultate as panting and vocalising, normal respiratory effort, normal bronchovesicular sounds
Gastrointestinal: Normal borborygmi, no palpable discomfort, no overt palpable organomegaly
Oral: Moderate generalised dental disease, no visible petechiae or ecchymoses, no dysphagia or hypersalivation 
Ears: NSF on external examination, would not tolerate otoscopic exam 
Eyes: NSF on limited exam, headshy
Integumentary and MSK: 
(1) LEFT hindlimb; 
- No palpable subcutaneous swelling in the region of the left stifle, no pain or palpable instability on external palpation of TPLO plate site, no visible draining sinuses or wounds, site euthermic compared to surrounding tissue 
- Fully weightbearing at rest and while walking, no lameness noted 
- No crepitus or discomfort on flexion and extension of joints of the left hindlimb, ROM assessment challenging as Nandi distressed and pacing around the consult room
- Mild diffuse subcutaneous swelling in the distal hock region, extending from the mid-calcaneal tendon to the distal hock. Swelling is not palpably intra-articular or compressible, not focal (very diffuse). Calcaneal tendon palpably stable and comfortable, site is euthermic and no other significant findings on examination of hock region. 

(2) RHL and forelimbs; No palpable joint swelling, no externally palpable draining sinuses or discomfort. 
(3) No spinal or neck pain. 

Urogenital: Small, comfortable bladder, no discharge from vulva, NSF on mammary examination 
Neurological: No evidence of central or peripheral neurological deficits
Peripheral LN: WNL

Assessment and Plan: LEFT hindlimb lameness; 
- Discussed potential causes of previously observed lameness and subcutaneous swelling. 
- Given history and examination, recommend screening radiographs of both stifles and hocks under GA, with ultrasound of affected swollen region and screening CBC, biochemistry and electrolyte blood testing + clotting profile to assess for other causes. 
- Subcutaneous swelling observed within the region of the left hock may be redistributed subcutaneous swelling from a more cranial location secondary to trauma vs other causes. Intra-articular swelling, swelling secondary to coagulopathy etc. cannot be ruled out definitively without investigations as recommended above. 
- Owner advised that he subjectively feels that the swelling has improved and Nandi has otherwise been stable, hence has elected to monitor. Discussed monitoring parameters, recommendation for strict rest etc. 
- If no further improvement or incomplete resolution within 3-5 days, or if deteriorates, recommend to revisit immediately or seek veterinary attention at after hours emergency hospital if required. 

recheck

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Wound looks great
No signs of infection/inflammation
Removed the plaster
Cone can come off
Slowly back to normal exercise
MO reports P doing really well at home - no signs of discomfort