C10018344 / invoice 10000

Reason: Lump On FootAppointment Notes: hkSummary: Paw irritation. Overweight.Current history:- EDDU: Reports eating and drinking well. Normal toileting. Owner concerned about a lump on the side of right fore digit 2 paw pad, first noticed the dog licking the paw on Monday. The area appears bruised and was more swollen this morning. Ruby is irritated when the owner palpates the area.- Current medication: Nil- Known medical conditions: Chicken allergy, back issues limiting exercise.- Current diet: Beef-based biscuits (chicken-free), one scoop morning and night. Liver treats for training. Occasional dental stick or toilet roll. No human food.**Clinical Exam** B&A- MM: pink refill < 2 secs- Oral cavity: v mild calculus- Eyes: NAD- Ears:NAD- Cardiac: NA - Respiratory: Panting- Abd palp: NAD- BCS: Overweight. Square appearance, lacking waist.- Temperature: NT - MSK: Examination of the left front paw reveals one pad is darker and appears bruised compared to the others. There is pinkish discolouration. No foreign body was identified. Other paws are mildly pink.- Skin: NADASSESSMENT:- Paw Lesion - Likely Inflammatory: is unusual looking as appears to be more a bruised and inflamed appearance of the side of the pad pad suggests possible trauma, a bite, or a sting with a secondary infection. A grass seed is considered less likely due to the atypical location on the edge of the pad. The initial plan is to treat with oral anti-inflammatories and antibiotics and to wash the paw with Malaseb shampoo. If there is no improvement in 7-10 days, the next step would be to anaesthetise, explore the area, and take a biopsy.- Overweight: Current weight is 41 kg. Despite a limited reported food intake, the dog is overweight. Hypothyroidism is a possible differential. The owner was advised to recalculate the feeding amount for a 40 kg dog, check the fat content of the biscuits, and consider low-calorie vegetable treats (e.g., carrot, capsicum, cucumber, zucchini) to reduce carbohydrate intake. Thyroid testing (T4) was discussed as an option if weight does not respond to dietary changes. Prescription diets are also available.Treatment:- Oral anti-inflammatories and antibiotics dispensed.- Malaseb shampoo dispensed.- Counselled owner on the use of Malaseb shampoo for paw washing.- Discussed signs of hypothyroidism (lethargy, weight gain, reduced engagement, cold intolerance, bacterial skin conditions).- Discussed dietary management for weight loss.    Vital Signs    Weight: 41.8;