C10016207 / invoice 10000

Appointment Notes: ?KJrecheck FOOT HR?????SUMMARY* Four-year-old Australian Cattle Dog presented for recheck of lameness, pyrexia, and an abnormal toenail, with poor response to a recent course of antibiotics.* Examination revealed a temperature of 39°C and a significantly enlarged popliteal lymph node on the affected leg, suggesting an active, resistant, or undertreated infection.* Treatment involves changing to a different antibiotic for 10-14 days and continuing Loxicom, with a plan to re-evaluate in two weeks. Further diagnostics (radiographs, lymph node sampling, culture) are planned if there is no improvement.History:History: Beau is a 3-year 10-month-old Australian Cattle Dog presenting for a recheck of lameness that began yesterday. The owner observed him to be non-weight bearing on one leg and noted an outer toenail appeared "poked out". He was seen last week for a wounded infection on the same limb, for which radiographs were taken and a course of antibiotics was prescribed. The owner reports missing one dose of the antibiotic, with one tablet remaining. Beau is currently receiving Loxicom once daily. The owner reports he is eating and drinking well and his general behaviour is normal, aside from the limp. He seems uncomfortable but not overtly painful when resting.Exam:Demeanour: BARVital signs:- Temperature: 39°C- Heart rate: not done- Respiratory rate: not done- Eyes: eyes clear, no signs of conjunctivitis, pupils symmetrical and normal size- Ears: vertical ear canals clear, full otoscopic exam not performed today.- Oral: Mucous membranes pink, moist CRT <2s.- Nose: nares clear, no discharge- Peripheral Lymph nodes: Significant enlargement of the popliteal lymph node on the affected leg palpated.- Cardiovascular: No heart murmurs auscultated, normal rate and rhythm.- Respiratory: normal lung sounds with no crackles / wheezes- Skin: Affected outer toenail appears scuffed.- Abdomen: relaxed on abdominal palpation, no masses or organomegaly noted.- Rectal examination: Temperature: 39°C. Digital exam not performed.- Musculoskeletal: Lameness on affected limb, non-weight bearing at times. Sensitive to palpation of the foot. Holds leg slightly abducted when lying down.- Other Findings:Laboratory tests: not applicableProblem List:* Lameness* Pyrexia (39°C)* Enlarged popliteal lymph node* Poor response to initial antibiotic therapyAssessment:* Persistent pyrexia and development of significant popliteal lymphadenopathy despite recent antibiotic therapy.* The clinical signs are highly suspicious of an active bacterial infection.* Tentative diagnosis is a bacterial infection that is resistant to the previous antibiotic or has been treated for an insufficient duration.* Melioidosis was mentioned as a RARE differential.Treatment:* Discontinue previous antibiotic.* Start a new, different antibiotic, to be given once daily for 10-14 days.* Continue Loxicom once daily.Client communications:* Discussed that the elevated temperature and enlarged lymph node indicate an active infection.* Explained the two likely reasons for treatment failure are insufficient duration of therapy or bacterial resistance.* Outlined the plan to change antibiotics and re-evaluate.* Advised that if there is no improvement, further diagnostics including lymph node sampling, repeat radiographs, and culture and sensitivity testing would be recommended.* Owner gave consent for the proposed plan.Plan:* Recheck consultation in 10 to 14 days to assess response to therapy.Additional:-Notes to reception:* Book recheck appointment with HR in 10-14 days.* Dispense prescribed antibiotic.??09/03/2026 4:53:51 PM MDV:f/up SMS sent???    Vital Signs    Weight: 23.2;       Temperature: 39;