C10027091 / invoice 10000

WEIGHT: 31.80
HISTORY: Subjective
Presenting Concerns:
-   Gus presented for evaluation of a split right dewclaw. The owner reports it has been bleeding, and he has been licking it constantly since it was noticed last night.
  
Historical Conditions:
-   History of separation anxiety, which is a pre-existing condition and not covered by his insurance. The owner has attempted behavioral modification techniques, including gradual departures.
-   History of a previous infection at an injection site.
  
Current Medications:
-   Trazodone: 2-2.5 tablets are given 2 hours before an anticipated stressful event. The owner reports it may be becoming less effective.
  
Lifestyle Risk Factors:
-   Attends dog daycare.
-   Lives in a household with a cat; they do not get along.

Objective
Mentation: BAR  
Wt: 31.8 kg  
BCS: --/9  
T: Not taken  
P: —  
R: —  
MM: pink/moist. CRT < 2sec.  
Hydration: Normal  
  
Emotional Assessment: The patient has a friendly and social temperament.  
  
Eyes: Clear. No discharge or erythema OU.  
Ears: Clean with no discharge or erythema AU.  
Nose: Clear, moist without discharge.  
Throat: No inducible cough upon tracheal palpation; no palpable masses.  
Oral: Calculus and gingivitis absent. No masses or other lesions.  
Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  
Respiratory: Normal bronchovesicular sounds bilaterally.  
Abdominal: No organomegaly or mass effects. No pain on palpation.  
Lymph Nodes: No peripheral lymphadenopathy.  
Integumentary: No evidence of ectoparasites, full coat with clear skin.  
Neurologic: No ataxia, normal mentation.  
Musculoskeletal: Ambulation normal, no lameness observed. The right front dewclaw is avulsed and hanging by a thread, with the underlying bone exposed. The area is painful. A local anesthetic was applied to the area. Cranial cruciate ligaments were checked for insurance purposes and are stable bilaterally.  
Urogenital: Normal external anatomy.  
Rectal: Not performed.

Assessment
Avulsed right front dewclaw - Traumatic injury with exposure of the underlying bone. There is a risk of secondary infection (osteomyelitis) due to the nature of the injury.  
  
Separation anxiety - Chronic behavioral condition managed with situational medication.

Plan
Medications/Treatments:
-   An anti-inflammatory medication was prescribed at a dose of 0.75 tablets PO SID with food for pain management.
-   Antibiotics were prescribed to prevent infection of the exposed bone.
-   A new Rx for Zactin was provided with 5 repeats. The dose is 2-2.5 tablets PO, to be given 2 hours before anticipated stressful events.
-   The injured paw was cleaned and a bandage was applied to protect the site and prevent licking.
  
Additional Discussion:
-   A recheck appointment is scheduled for Monday to re-evaluate the paw and remove the bandage.
-   To prevent licking of the bandage, the use of an inflatable cone or the application of Vicks VapoRub to the outside of the bandage was discussed.
-   It was discussed that a referral to a veterinary behaviorist for the separation anxiety is unlikely to offer strategies beyond what has already been implemented.
-   The insurance form regarding the cruciate ligament examination will be completed.

HISTORY: script for zactin

WEIGHT: 30.05
HISTORY: recheck lump inside left fore, now 1 x 1.1cm, has reduced from 1.3 x 1.7cm. hardly licking it.
its a regressing histiocytoma. no need to remove but to recheck 4 weeks to ensure gone completely.
since being on cephalexin, has been a bit picky eating, has had the odd v+ and drinking a lot and panting. has 2 days left, to finish this course as histiocytoma is a little purulent in the centre.
if remains lethargic, pu/pd etc once finish antibiotic, review for bloods