C09970819 / invoice 10000

NURSE: MS
HISTORY: been panting and wobbly - cannot jump on bed anymore
said panting before meds given 
seems to be protecting back area
lethargic and seems alot
EDFU normal
will urinate normally but does a lot of little wees 
-DietBilly Margot - chicken and superfood. grain free. 
-Env indoor outdoor
-Comp
-Prev
Current Meds: gabapentin
DOG ADMITTED FOR XRAYS WITH CONCERN OF ABDOMINAL FB WITH NO VET EXAM. owner initially wanted to wait but  would not be done for a while as missed appointment and fully booked. 
-Insurance?
SUBJECTIVE:
OBJECTIVE: T= 37.9 MM pink CRT <2 sec HR = 100 FP RR panting RESP:NAD
BEHAVIOUR ASSESSMENT:lethargic, quiet. 
BCS: /9
GIT: gut sounds present, comfortable. rectal large prostate, nonpainful. 
U/G:large prostate, right possibly large than left  . small bladder
NEURO: no ataxia or weakness on exam. normal proprioception
M/S: neck pain when turn head to the right , nil dorsally or ventrally. possibly some mild when turn to the left. nil pain on palpation of neck or back. 
SKIN:NAD 
OPHTH:NAD
OTIC: NAD
LYMPH/N:
ASSESSMENT: neck pain 
Enlarged prostate- entire male or significant
RADIOLOGY : prostate appears enlarged and in pelvic canal. descending colon/rectum appears displaced drosally. 
rest of organs appear normal. some gas in the ileocaecal junction. empty stomach. no abnormalities detected in the vertebrae seen. normally spacing
neck - no abnormalities seen. 
called owner discussed findings. permission to collect blood and urine samples 
URINALYSIS:
MACROSCOPIC
Collection method:feed catch - only passed small amounts 
Colour / Appearance:

CHEMISTRY:
USG:      1.040                               pH:7
Protein:                 +              Bilirubin:-
Glucose:          -                   Ketones:-
Blood:-

MICROSCOPY
WBC:      50    /HPF
RBC:    10       /HPF
Epithelial:++
Crystals:nil seen
Bacteria: nil
Casts:nil
Other:
prostatitis? vs neoplasia. 
blood collected for comprehensive profile. not relayed andy results to owner as ran them late in the day but booked in for sedation and ultrasound +/- prostatitic wash with urinalysis and culture  as approripate. send estimates ready for monday
no ABs given in case need to culture and no bacteria seen. started on meloxicam with discussion that if starts to pass diarrhoea or vomit needs to stop but  may resolve neck pain with this. Understands the reason we did not dispense this in the first place was we could not localise the issue - no pain response in neck last time. 
Tx OPTIONS:
TREATMENT:buprenorphine 0.12mg and meloxicam 1.5mg  SQ
home on meloxicam 0.75mg sid 
PLAN:booked in for investigation
DISCUSSION:
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DISCHARGE
Today we have performed x-rays for Bingo, he was such a good boy for all his treatments. 
We have given him an injection of anti-inflammatory and some really good pain relief, this may make him drowsy for he rest of the afternoon (up to 8-10 hours in total) . We also ran a compressive blood panel and urine test.  We will discuss the results on Monday. 
The Xrays show no abnormalities visible on an Xray in his neck but there may be some visible on CT or MRI. Please use a harness to walk him and do not connect him to a lead so we do not put any pressure on his neck. If he shows trouble walking, incoordination or weakness he should be seen by a vet as soon as possible as there may be compression on his neck blocking the communication between his brain and legs. We have started him on some anti-inflammatory pain relief that may help resolve his neck pain however please stop this if he shows any signs of an upset gut eg vomiting, refusal or less enthusiasm for food or diarrhoea. 

 We also found he has a large prostate and is not urinating normally. We also suspect his stools are narrow because the prostate is blocking the passage a  little. 
We recommend an abdominal ultrasound to assess his prostate. He may need a prostatic wash to culture to see what infection we are dealing with, if any . It may also reveal abnormal cells. We may need to give him a long acting injection to medically castrate him and stop the testosterone and other hormones that feed the prostate activity and size. This may also mean surgical castration in the near future. 
We have booked him in for sedation and ultrasound on Monday. We may recommend a prostatic wash while he is in hospital which will require a full anaesthetic. 
Please read and follow the pre surgery information to help you prepare him for his procedure on Monday. He should have access to water at all times. 

Please read your medication label carefully and follow instructions. We have booked him in for an Ultrasound on Monday, if you have any concerns or issues before then please contact the after hours clinic: MASH 1800 838 787 

 If you have any concerns or queries please do not hesitate to contact the clinic 

doing well - drowsy last night - perked and went for walk
edud normal
still little tired - did yelp when lifted him but otherwise resting