C10022004 / invoice 10000

Reason: Recheck - Getting Worse NTHistory: Presented for a free check of a hot spot. The owner reported the hot spot was increasing in size since commencing Cephalexin and Apoquel on Tuesday. This is the first reported incidence of a hot spot. An attempt to clip the area on Monday caused stress, so medical management was initiated. As medical treatment alone has not been effective, sedation for clipping and cleaning was recommended.Current Diet: Not mentionedVaccination: OverdueParaciticides: OverdueCurrent Medication: Apoquel 16 mg BID, Cephalexin 600 mg BID.Pre-existing conditions: noneAccess to toxins eg. Rodenticide: Not mentionedExamination:BEHAV/DEMEAN:	Stressed during initial attempt to clip the lesion.HYDRATION:	Hydration clinically adequateCARDIOVASC: 	Cardiac auscultation normal. Mucous membranes pink, CRT <2 seconds. HR 135 bpm.RESP:	 	Panting. Thoracic auscultation clear sounds bilaterally.ORAL: 		Normal, no mouth pain, not gradedEYES: 		Clean and clearEARS: 		Clean and clear, no odour or dischargeINTEGUMENT: 	Large area of acute moist dermatitis (hot spot) on the dorsum, extending from the back of the head, caudally to in front of the shoulder blades, and down the side of the neck.NEURO: 		Neurologically no significant findingsMSK: 		Ambulating normally, no palpable neck, spine, limb or joint painABDOMINAL: 	No detectable pain on abdominal palpationUROGENITAL: 	NSFLYMPH NODES: 	NSFRECTAL: 	Not performedAssessment:Problems1. Acute moist dermatitis (hot spot), non-responsive to oral medication alone.2. Stress/anxiety associated with clipping.Anaesthesia:Premedication:Medetomidine 0.02 mg/kg (0.56 mL) administered IMButorphanol 0.1 mg/kg (0.28 mL) administered IMMonitoring: Assessed as ASA grade 1.Procedure: Sedated for clipping and cleaning of hot spot. The affected area on the back of the head, neck, and shoulder region was clipped widely. The skin was cleaned with Malaseb shampoo with a 10-minute contact time. 0.5 mL of Cortavance was instilled into each ear canal. Malaseb was also applied to the interdigital spaces. Reversed with atipamezole 0.56 mL IM. Recovered with the owner.Post-operative Treatment:1. Atipamezole 0.56 mL IM for reversal.Plan:Continue current medications (Apoquel and Cephalexin).Revisit in one week for recheck, or sooner if the lesion worsens or continues to increase in size.Client communication:Discussed the requirement for sedation to clip and clean the hot spot. The owner provided consent for the procedure and associated costs ($425 - $510).The risks of sedation were discussed, including regurgitation and aspiration pneumonia, noting the risk was low as the last meal was at 9:00 a.m. and the procedure was at 1:30 p.m. The anaesthetic risk was classified as ASA 1 (healthy patient).The owner was present for recovery. Discharge instructions provided regarding medication and recheck plan.    Vital Signs    Weight: 28;       HeartRate: 120;       DentalGrade: 1;       RespirationRate: Pant;       PainScore: 1;       CRT: < 2;       MMColour: PInk ;       BodyScore: 5;