C09971122 / invoice 10000

WEIGHT: 23.90
HISTORY: History:
O has noticed increasing stiffness in back legs. Still EDDU normally and happy in themselves otherwise. No vomiting/diarrhoea. Not UTD with parasite prevention. Used to have Bravecto but seizured afterwards. Sometimes coughs after exercise.

PE:
BAR, MM pale pink & moist, CRT <2s
BCS - 3.5/5
Nose - clear
Eyes - bilateral nuclear sclerosis
Ears - clear
Oral cavity - 1/4 dental disease, worn teeth
LNs WNL
Cardiac auscultation - NAD
Pulmonary auscultation - panting, harsh resp sounds
Abdominal palpation - NAD
Skin and coat - NAD
Musculoskeletal - stiff gait in HLs, painful on palpation of epaxial muscles at level of shoulders and again over sacrum, marked pain response on extension of hips, moderate pain response on extension of stifles.

INH pre-GA profile - biochem WNL, machine unable to read haematology

Assessment:
Likely OA pain
Coughing and slightly pale gums - possible cardiorespiratory disease

Treatment:
Blood --> IDEXX for haematology review.
Discussed cough and further investigation with imaging - O declined is just wanting to focus on pain relief for patient.
Meloxicam 0.1 mg/kg, 1.5 mL  SID PO
Paracetamol 500 mg 1/2 x  BID-TID.
4cyte.

HISTORY: Synovan inj SC

WEIGHT: 23.80
HISTORY: Patient has had a couple of 'turns' in last few months - 2 x episodes have occurred where patient collapsed and was moving legs around, seems semiconscious during episodes. EDDU normally otherwise. Mobility going well.
CLIN_EXAM: BAR, MM pink & moist, CRT <2s
BCS - 3.5/5
Nose - clear
Eyes - bilateral nuclear sclerosis
Ears - clear
Oral cavity - 1/4 dental disease, worn teeth
LNs WNL
Cardiac auscultation - NAD
Pulmonary auscultation - NAD
Abdominal palpation - NAD
Skin and coat - NAD
Musculoskeletal - NAD
TREATMENT: Synovan 0.7 mL SC
Discussed intra-cranial VS extra cranial causes of neuro episodes
Monitor for now, if increasing in frequency/severity consider seizure workup with bloods etc but more likely to be intracranial disease given patient's age