C10028151 / invoice 10000

Appointment Notes: Sore dew clawO noticed this morning that Cash has a sore front left few claw. Noticed him licking at it this morning. No noted trauma. Walking normally. Examination:Demenour - BARBCS - 3HR/RR - WNL'sCRT/MM - <2sec, pink and moistTeeth - 0Eyes/ears/nose - NADLymph nodes - NADSkin - moderate hyperaemia and oedema of the nail base of the left front dew claw. Exudative discharge around the nailAbdo - NADGait/musculoskeletal - NAD.Assessment:Paronychia of the left front dew claw.Treatment:1) Dispensed Previcox tablets (227mg, 1 tab x sid with or without food).Plan:- Ensure Previcox is only give sid. If vomiting or melena occur, to discontinue and re-check.- Re-check if no improvement.- If licking occurs, will need an e-collar placed.    Vital Signs    

Reason: Re-check Lump.History:The lump on the dorso-lateral aspect of the L FL MC's seems to have decreased in size by about half. No pain on palpation. O has been giving Previcox and Ceph as dispensed. Examination:Skin - Lump has decreased by about 50%. No pain on palpation and hyperaemia has resolved. Gait - NADMusculoskeletal - As per last visit. Assessment:Resolving swelling over the dorso-lateral aspect of the L FL MC's (DDx: migrating FB, tendonitis, cellulitis, bone spur, joint infection, fracture, other).Advised Alison & Lachlan that the swelling has decreased in size and there is no pain on palpation of the swelling. Discussed options including ongoing conservative Tx with NSAIDs Vs rads +/- exploratory surgery. At this stage, will continue with NSAIDs and if swelling increases in size or lameness recurs, to consider rads +/- surg. Treatment:1) Dispensed Previcox tablets (227mg, 1 tab x sid).Plan:- To give the entire course of Previcox. If vomiting or tarry faeces occur, to discontinue and re-check.- If lameness or swelling increases, to consider rads +/- surgical exploration.- Try to keep quiet for another 5-7 days.    Vital Signs    Weight: 27.5;       

Appointment Notes: Lame L FL - Swelling near toes. History:Cash has intermittent lameness of the L FL which was first noted on the 19/01/26. A swelling developed above the L toes. Still active and doesn't seem to bother him too much. One of his L FL toes has always slightly deviated. Doesn't worry him and doesn't get traumatised.Eating/drinking/urinating/defaecating normally.Examination:Demenour - BARBCS - 3HR/RR - WNLsCRT/MM - <2sec, pink and moistTeeth - 0Eyes/ears/nose - NADLymph nodes - NADSkin - Discrete, well circumscribed, raised swelling on the dorso-lateral aspect of the L metacarpals. Warm and hyperaemic. Measures 2cm x 1.5cm. Mild pain on palpationAbdo - NADGait - Grade 1 L FL lamenessMusculoskeletal - Good ROM of all joints. No pain on extension or flexion of shoulders, elbows, carpi, digits. L FL D4 is sprung with ligament laxity noted. No obvious palpable fractures or dislocationsNeuro - NAD.Assessment:- Swelling over dorso-lateral aspect of the L FL MCs (DDx: migrating FB, tendonitis, cellulitis, bone spur, joint infection, fracture/dislocation, other)- Sprung D4 (digital flexor tendon and collateral laxity)Discussed the above with the O. Recommended an FNA of the swelling. O has consented. Treatment:1) FNA of swelling - Consistent with inflammation (occasional cocci, RBCs +, neutrophils +, macrophages +, no neoplastic  cells observed.Based on CSx and FNA, recommended initial conservative Tx with ABs, NSAIDs and rest. If worsens or no improvement, may need to consider rads +/- surgical exploration.2) Dispensed:- Ceph (600mg, 1 tab x bid).- Previcox tabs (227mg, 1 tab x sid).Plan:- Keep quiet for 5-7 days.- Ensure that the entire course of Ceph is completed- To give Previcox SID. If vomiting or malaena occurs, to discontinue and re-check.- Re-check in 1 week. - If worsens or no improvement, may need to consider rads +/- surgical exploration.- Sprung toe shouldn't be problematic, but if it becomes continually traumatised, may need to consider digit amputation.    Vital Signs