C10026477 / invoice 10000

13/03/2026 Presenting Complaint: Swelling on right hind paw, inside toe, worsening despite treatment.

Hx: Swelling first noticed Sunday night, bleeding at that time. Seen by Matt 3 days ago who performed fine needle aspirate showing inflammatory cells (neutrophils and macrophages). Started on antibiotics one tablet twice daily and topical cream with steroid. Swelling has continued to enlarge despite treatment. 
Hopping on grass, protecting the paw, licking at it. Up in the night licking. Owner has been using sock to cover. 
No previous swellings like this. Owner concerned about possible spider bite or foreign body.

PEx: 
Temperament: BAR
BCS: 5/9
MM: pink and moist, CRT: 1-2 sec
Mouth: NAD
eyes: NAD
ears: NAD
nose: NAD
Cardiovascular: HR: 140 = PR. Murmur: No
Respiratory: RR = wnl, lung sounds are normal
Lymph nodes: NAD
Abdominal Palpation: NAD
Skin/Coat: Right hind paw - large alopaecic erythematous swelling on the plantar medial aspect of the inside toe, painful, extends ~1cm proximal under the skin. Purulent material obtained on fine needle aspirate.
Musculoskeletal: Hopping on grass, protecting right hind paw
Genitalia: NAD

Laboratory results: Fine needle aspirate performed today - purulent discharge - lots of macrophages and neutrophils with marked blood contamination. 

Assessment: 
Right hind paw abscess - suspect grass seed foreign body. Differential diagnoses: foreign body abscess (grass seed most common), infected puncture wound, spider/insect bite with secondary infection, tumour (less likely given inflammatory cytology).
Swelling has worsened despite antibiotics, suggesting persistent foreign material requiring surgical removal.

Plan: 
Surgery Monday for lance and investigate under general anaesthetic. Pre-anaesthetic blood test to be performed. Clip and prep whole foot. Incise abscess, flush thoroughly, investigate for grass seed or foreign material. May leave open to drain or close depending on findings. Bandage for a few days post-operatively.
Continue antibiotics for now and will likely extend this ~ a week post surgery. 
Stop topical cream for now - continue antibiotics only.
Keep paw covered with sock when supervised, cone of shame when unsupervised.
Trazodone to be given 3 hours before admission (approximately 5:20-5:30am) with small amount of food.
Admit 8:20am Monday. No food from 8-9pm night before, water okay overnight.
Estimate approximately $1600. Pre-approval for pet insurance to be arranged.

Consult Summary: 
Presented for worsening swelling on right hind paw despite antibiotics and topical cream. Fine needle aspirate confirms abscess, likely grass seed foreign body. Surgery booked for Monday to lance and investigate under general anaesthetic. Continue antibiotics and trazodone given for pre-anaesthetic sedation.