C10032251 / invoice 10000

HISTORY
Presenting for: Chase, a 5-year-old dog, presented for a torn nail with blood drops observed in the house.
Current Meds: Does not use wet food, tries to avoid it

EXAM
Mentation: BAR
Wt: 32 kg
Behavioural: Food motivated, accepts treats during examination
Eyes: Right eye producing extra moisture/tearing, no abnormal hairs visible, eye appears normal otherwise. Left eye normal.
Ears: Requires cleaning, especially while in E-collar due to moist weather conditions
Integumentary: Fifth digit on right front paw - nail shell completely torn off, painful lesion
Musculoskeletal: Fifth digit right front paw - complete avulsion of nail shell

ASSESSMENT
Nail avulsion (fifth digit, right front paw) - Complete shell removal, risk of secondary infection
Epiphora (right eye) - Suspected nasolacrimal duct obstruction

PLAN
New Meds/Tx:
- Oral antibiotics BID for 5 days to prevent secondary infection of nail bed
- Pain relief medication SID on food, dose at 32kg mark, shake well before drawing up
- Protective sock covering for affected digit, change daily to keep clean and dry, secure with light tape at top, use for 3-5 days until wound dries

Additional Discussion:
- Nail may grow back abnormally shaped, will require careful monitoring and trimming to prevent recurrence
- Possible nail bed infection as underlying cause, monitor new nail growth for abnormalities
- Examination of other nails planned once patient relaxed to check for signs of infection or immune-related nail changes
- E-collar to be worn to prevent licking/chewing at affected digit
- Daily ear cleaning recommended while wearing E-collar due to increased moisture retention
- Ear cleaner available for purchase ($60 clinic vs $25 PetSmart due to buying power differences)
- Photo taken of affected digit for medical records

Client Comms:
- Recheck appointment scheduled for Tuesday to assess healing progress
- Fluorescein stain test planned at next visit to evaluate nasolacrimal duct patency with adequate time for assessment
- Healing expected to take couple of weeks, will be painful initially
- Insurance coverage discussed for follow-up care

JK removed yesterday. Mild scrotal swelling and superficial scrotal bruising. Reapply JK. Redisp Clav/Rim 8d. Warm applications on scrotum bid. R/v 3d. 11/9 Client cancelled appt. Scrotal swelling has reduced reportedly. Compliance with medications dispensed 3d ago uncertain.

GA,castrate.JK. Oral buprenorphine and carprofen for pain relief.6d Clav tabs. Ace for sedation.