C10008601 / invoice 10000

Reason:  
History: 
O feels that the wound is half its size today. Seems to be less inflamed, only small central portion looks a little infected with crater in the central portion. 

Current medications: Carprofen, Gabapentin, Amantadine. 

Examine: 
Mentation: BAR 
Body condition score: 4/5
MM: P/M               
CRT: <2
HR: ~112            
RR: panting 
LN: increased popliteals (mild)
Temperature: not taken 
Cardiovascular: Grade 3 Systolic Murmur 
Integumentary & lumps (measurement, location): ~2cm nonhealing wound with significant thickening on point of right elbow 

Problem List/Assessment: 
Non-healing wound on point of right elbow, inflamed and mild infection present. Only about 1cm in size today so definitely getting smaller!
DDX: non-healing wound, burst hygroma, fb, neoplasia v other. 

Options:
- Continue managing conservatively with carprofen, gabapentin. Keeping area padded, discussed increasing passing around fabric sleeve. Adding clindamycin for infection today. 
- Could still consider surgical removal with primary closure. Stressed to O that very marginal removal would be performed and that there is high risk with the anesthetic and for post-operative breakdown. O less keen for this option at this stage. 

Reason: Courtesy phone call 
Nurse: EW 
History: wound CP.  TTPONACLM
     
Treatment:
     Medications being given: Carprofen, Gabapentin, Amantadine, Cephalexin. 
     Patient taking meds as prescribed? last abx 4/3/26, o will monitor and call if becomes infected.

O returned call.  Crater in centre of wound. No sign of infection, redness has gone down, keeping it dressed.

O calling insurance to see what is covered.  Will call to book in once had a chance to do.