C10008227 / invoice 10000

Reason: Lame On Paw That Had Toe AmpAppointment Notes: O thinks there's a growth where she had toe amputation . TKHistory:Presented for: RFL where digit 3 P3 amputated swelling and cystic structure in last 48 hours- Licking non-stop- No limping on itEDDU, no V+ or D+No other concernsEXAMINATION:Sf:Oral: grade 2/4 calculus grade 1/4 gingivitisIntegument: RFL where digit 3 located moderate swelling of skin, on palpation no pain reflex, very pruritic - trying to lick non-stop. MSK: weight bearing on RFL, no limping or lameness. No fracture or remnant of digit 3 palpated, no pain on RFL palpation. MM/CRT: P+M, <2 secondsOral: grade 2/4 calculus grade 1/4 gingivitisOptic: clear eyes, no hyperaemia in sclera of eye, no ocular discharge, PPL/menace/palepbral reflex intact, full exam not indicatedOtic: no discharge, no erythema of pinae, pinnae grossly normal, full exam not indicatedNasal: no obvious nasal discharge presentCVS: clear heart sounds bilaterally, no arrhythmias or murmurs auscultatedPulse: S+S, no pulse deficitRR: clear lung sounds bilaterally, no increased bronchointerstitial sounds, no crackles or wheezes auscultated, normal respiratory effortGIT: no organomegaly, no ascites, no FB detected todayLN: all peripheral superficial LN texture, shape and size WNLIntegument: RFL where digit 3 located moderate swelling of skin, on palpation no pain reflex, very pruritic - trying to lick non-stop. Neuro: no ataxia, normal mentation, no obvious cranial nerve deficits, full exam not indicatedMSK: weight bearing on RFL, no limping or lameness. No fracture or remnant of digit 3 palpated, no pain on RFL palpation. Demeanour: BARUrogenital: grossly normal, no discharge or erythema, full exam not indicatedRectal: rectal exam not indicatedASSESSMENT:RFL digit 3 marked pruritis and inflammation- DDx recurrence of lump (although no lump seen), remnant of P3 remaining causing pain, skin infectionO consented to treatmentTREATMENT:Cephalexin 1000mg x 10 tablets - HALF (1/2) tablet BID. Stop if V+ or D+. Finish full courseMetacam 2.5mg x 7 tablets - ONE tablet SID with food. Stop if V+ or D+E-collar for a weekPLAN:Went through medication with O.Due to inflammation on skin don't think FNA will yield much apart from neutrophils and cocci. If not resolving to FNA on recheck.Otherwise INI or worsening recc sedated radiographs - sent est.    Vital Signs