C10018588 / invoice 10000

Reason: Bitten by somethingARRIVAL TIME:SIGNALMENT: Young, Chow Chow, Male, EntireHistory Summary:Teddy presented for investigation of a potential bite on his left hind leg. The owner noticed him to be very anxious, agitated, and biting at his left hind leg approximately one hour prior to presentation. This behaviour was described as him being unable to get comfortable, running around the house in circles, and not being able to stand still. He was reportedly unwilling to eat chicken but was drinking water in small sips before running in circles and then returning to drink more. The owner applied an itch-relief product to the area, which accounts for the yellow discolouration. There is no lameness noted. The owner acquired Teddy a few weeks ago and reports he had a pre-existing skin condition which has since resolved. He has also been observed to shake his head and lean to one side. There is also a concern regarding his teeth, as he seems to have difficulty eating and may have an extra set of teeth. Vaccinations are believed to be up to date and a flea treatment was recently administered. O mentioned that he has had hot spots in the past. He has also been shaking his head. TRIAGE: Unable to perform initial triage without sedation due to being very anxious and boisterous HR: 80 bpm (post-sedation)RR: 28 breaths per minute (post-sedation)Temp: 39.9°C (post-sedation)MM: Pink & moistCRT: < 2 secondsMentation: Anxious and aggressive initially, sedated for examinationPain Scale (MGCS): Unable to assess initially due to behaviourHydration status (%): Appears adequately hydratedEXAMINATION:Body Condition Score: 5/9 Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous. Heart rate 60-80 bpm under sedation. No murmur detected.Respiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge. Respiratory rate 28 breaths per minute.Neurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performed.Musculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performed.Gastrointestinal:Oral: Pink moist mucous membranes. Dental score 1/4. No mouth pain noted. No obvious retained deciduous teeth.Abdominal: Comfortable on abdominal palpation, no abnormalities detected.Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): Both testicles present and symmetrical.Integumentary system: In-house ear cytology was unremarkable with no evidence of infection. Clipped both left and right hind limbs. No obvious wounds, bite sites, or foreign bodies such as a wasp stinger were noted. The skin was not red or inflamed. The rest of the skin coat appears normal with no evidence of erythema or hot spots.Lymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Acute onset agitation and discomfort, localised to left hind leg2. Pyrexia (39.9°C)3. History of skin issues and behavioural anxietyDIFFERENTIAL DIAGNOSIS:Insect bite/sting (e.g., wasp, ant) vs. hot spot vs. foreign body vs. allergies vs. traumatic wound vs. other. Pyrexia could be secondary to pain, stress, or an underlying inflammatory/infectious process. The behavioural signs could be related to pain, anxiety, or a combination.DIAGNOSTICS/MANAGEMENT PLANPlan to sedate for full examination, clip and clean the affected area, and perform baseline blood tests and in house ear cytology to investigate pyrexia. An estimate of $800-1500 was provided and the owner consented to proceed. A GapOnly pre-authorisation was submitted.Sedation was administered with methadone 0.3 mg/kg IM and medetomidine 15 mcg/kg IM. A full examination was performed under sedation.Blood Gas Analysis Results - source: venous-Interpretation: UnremarkableBloods were taken for in-house testing:Full bloodsComplete Blood Count  - Please find attached to the patient record.  - Findings: Mild leukocytosis with a mild neutrophilia, consistent with a stress leukogram.Biochemistry  - Please find attached to the patient record.  - Unremarkable.In House ear cytology - no evidence of bacteria or yeast infection in either ear. REVISED ASSESSMENT:Pyrexia of unknown origin. The agitation is likely secondary to a painful or irritating stimulus (e.g. insect bite vs. other) that is no longer apparent. The pyrexia may be secondary to stress and pain, but an underlying inflammatory process cannot be ruled out. No evidence of an ear infection was found. Full bloods unremarkable TREATMENT SUMMARY:Methadone  0.3 mg/kg IM for sedation and analgesia.Medetomidine 15 mcg/kg IM for sedation.Sedation reversed with atipamezole 0.3 mL IM.OWNER COMMUNICATION:Discussed with the owner, Jess, the presenting complaint of acute onset agitation and discomfort localised to Teddy's left hind leg. The owner described him as being unable to get comfortable, running in circles, and refusing food.An initial examination was not possible due to his significant anxiety and aggression.Two main options were presented to the owner:1. **Proceed with sedation tonight:** This would allow for a thorough examination of the affected leg, clipping and cleaning of the area, a full physical assessment, and baseline blood tests to investigate the cause of his signs and the noted pyrexia. A financial estimate of $800-$1500 was provided, and the process for submitting a GapOnly pre-authorisation was explained.2. **Pre-visit sedation for a follow-up appointment:** This would involve discharging with oral sedatives (trazodone and gabapentin) to be administered prior to a visit with their regular veterinarian. This would aim to reduce stress and allow for an easier examination at a later time.The owner expressed a preference to proceed with sedation and diagnostics tonight due to her concerns. She provided verbal consent to the proposed plan and the associated estimate. The plan to sedate, examine, run diagnostics, and then reverse the sedation was outlined. The risks associated with sedation, including the potential for a drop in heart rate, were also discussed, and the plan for close monitoring was explained.Discussed with the owner, Jess, that after sedation and examination, no obvious cause for the signs could be found on the hind limbs. The skin was not inflamed and there were no bite marks. The pyrexia was noted, and blood tests were performed which showed a stress leukogram but were otherwise unremarkable. In-house ear cytology was also unremarkable. Discussed that the cause may have been an insect bite where the stinger has fallen out. Advised on the plan for discharge and monitoring. Discussed pre-visit sedation with trazodone for future vet visits, including for desexing, to manage his anxiety.FINANCIAL UPDATE: 800-1500PLAN:Discharge home with instructions to monitor closely. If symptoms persist or worsen, a recheck with the regular veterinarian for further diagnostic workup is recommended. Advised to use trazodone as prescribed for future vet visits to manage anxiety.For any questions regarding the case, please contact the Underwood and Jindalee Clinical Support Line at 07 3147 8746 (Mon-Fri, 9am-6pm), or our hospitals during after hours.    Vital Signs