C10014607 / invoice 10000

In with Hilary Hx:- Had a big play at the creek yesterday. Since then O noticed a mild intermittent limp in the RFL. No obvious excessive licking. - Doing well, no concerns otherwise- EDDU normal- No V+, D+, coughing, sneezing- No ongoing medications currentlyPE:BAR, can be reactive and will growl frequently throughout consultation. Focused PE performed on the table with O restraining her. Ambulation: Ambulatory x4. Slightly ginger in the RFL but still able to weight bear.MSK: Normal ROM and joint manipulation in the RFL. No pain on long bone palpation. Exam of the RFL paw: The skin at the ventral IDS was erythematous, inflamed and the fur was moist. Clipped for better visualisation and 1x puncture wound was noted in between ventral D3 and D4. There were small amounts of blood-tinged purulent discharge from the area. Attempted to explore with alligator forceps but she was non-compliant. Area was cleaned with diluted chlorhex.Assessment:Limping RFL: Suspcious of GSA vs sharp penetrating puncture woundRx: n/aPlan:- Offered 2 options today as she is non-compliant for exploration:1) Sedation + proper exploration of the area. Warned about potential of negative explore.2) Trial on medical management and monitor for improvements.O elected for option 1 however just fed her an hour ago. Elected for sedation tomorrow with a vet and we will expllore the draining sinus for any FB. O was made aware again that it might be a negative explore. O happy to proceed. Will fast overnight and bring her in tomorrow for the sedation. No meds until tomorrow. 

In with HilaryHx:- Doing well, no concerns at all- EDDU normal- No V+, D+, coughing, sneezing- Due for C5 vacc todayPE:BAR, cautious dog. Will growl but O is good at restraining and calming her down. No signs of aggression. Better on the table. BCS: 5/9EENM: NADMM pink, CRT 1.5 secDentition: DDGR 0-1/4CVS: NAD. No obvious murmurs or arrhythmias. Femoral pulses normodynamic and synchronous. Resp: NAD. No abnormal bronchovesicular soundsAbdo palp: No pain palpatedAssessment:DDGR 01-/4Fine for vaccRx:- Duramune C4 + BB injectable in dorsum SQPlan:- Pi2 + BB in 1 year. Duramune in 3 years- Recommended to continue with dental interventions to slow down progression of dental dz. 

In with female O.History:Was off food with d+ last week but seemed to have resolved and eating fine now.O noticed a scab around L flank and has been applying antiseptic ointment for a few days. O did some googling and is concerned about a hospot.Doing well otherwise no other concerns.Examination:BAR, growling prioritised exam of L flank and nailsL flank: matted hair scabbing which is easily clipped away, underlying skin looks fineNails clipped with muzzle on. Growls and tried to bite once but overall not too bad.No further treatment needed.