C09971196 / invoice 10000

Consultation Time: 12:30pm History:Ruby presented today for investigation of hindlimb weakness, reluctant to get up and walk around, mild lethargy and inappetence this morning. Yesterday owners got home at 4:30pm - back door usually open so she can go in and out and Ruby usually greets owners enthusiastically when they get home. Yesterday Ruby was standing at the back door and seemed "frozen" and reluctant to come inside. Owner offered food and she was able to walk normally and did eat food offered. After this she was shaking a lot and seemed uncomfortable. Last night she returned to her normal self and was playing with a puppy that came to the home for a visit. This morning when O got up, Ruby was not moving again, reluctant to stand and seemed more lethargic. She was offered food and actively refused to eat. This is very unusual for her as she is normally a very good eater. Not drinking much water. No vomiting or diarrhoea noted by owners. No PU/PD - owner concerned she does not drink enough water. Normal urination - no lower urinary tract signs noted by owner but doesn't often see her urinating. No access to toxins. Not known to scavenge or eat things. Doesn't play with toys. Generally Ruby has been slowing down a bit on walks - O's attributed this to heat and age related change. Still has moments of puppy like behaviour and will play enthusiastically with other dogs. No changes to respiratory effort but owner does report more panting recently - attributed to heat. No dyspnoea or coughing. No changes to bark. No stridor or stertor noted. No lameness noted previously. No known weight loss. Chronic illnesses: None known. Has a few lumps - O reported they are lipomas. Neuro: No neurological signs noted by ownerLast vet visit: Two years ago. Preventatives: Unsure but thinks so. UTD with vaccinations Regular vet: Point Cook Pet-ODiet: Kibble - no human food, odd piece of cheese or ham. Did give new treats from the butcher yesterday prior to development of clinical signs. Medications: None Subjective:BAR. Normally ambulatory on presentation. Objective:Temp: 38.5    MM: Pink and moist      CRT: <2   HR: 120     FP: Strong and synchronous      RR: pantingBCS:  5/9       Wgt:  28.4kg Pain Score (CSU):   1/4CV: Cardiovascularly stable. Grade 3/6 left sided systolic murmur, no arrhythmia. RESP: Panting, normal effort. Normal thoracic auscultation             GIT: Query mild splinting on deep abdominal palpation. Normal rectal examination. Anal glands empty - no masses palpable. U/G: WNL Neuro: Normally ambulatory. Normal mentation. Cranial nerves WNL. PLR and menace intact. Intact CPs. No ataxia. No spinal or neck pain appreciatedM/S: Resents flexion and extension of hips and stifles bilaterally. Integ: Normal - some lipomas which have been aspirated at regular vet. Ophth: Mild nuclear sclerosis bilaterally. LNs: WNL Initial Tests:INTERNAL LABORATORYLACTATE:  2.2mmol/L	Blood Gas(sample type: venous)Abnormal parameters: PCO2 31.4 (33 - 52) LCl 122 (106 - 120) HCa 1.42 (1.13 - 1.33) Interpretation:Mild hyperchloraemia - may represent mild dehydration Mild hypercalcaemia - Ddx: spurious vs hypercalcaemia of malignancy vs hypoadrenocorticism vs hyperparathyroidism. Reassess. CBCAbnormal parameters: NoneBiochemistryAbnormal parameters:Amylase 1818 (500 - 1500) Lipase 5630 (200 - 1800) Problem List:Problem list:1. Hindlimb weakness and reluctance to walk - Ddx: weakness secondary to systemic illness vs MSK pain vs other. Appears to have resolved - no signs of weakness in consultation today. 2. Inappetence this morning - Ddx: mild gastroenteritis vs pancreatitis secondary to fatty treats given yesterday. No metabolic cause identified on bloodwork. Mild abdominal pain noted on palpation. 3. Grade 3/6 left sided systolic murmur identified today - Ddx: myxomatous mitral valve disease vs cardiomyopathy. Requires reassessment. Difficult to auscultate clearly today as resented having mouth closed and panting heavily. No clinical signs referrable to cardiac disease noted by owners. 4. Mild ionised hypercalcaemia - Ddx: spurious vs hypercalcaemia of malignancy (anal gland adenocarcinoma vs lymphoma vs other) vs hypoadrenocorticism vs hyperparathyroidism. Recommended recheck of this if possible at regular vet, more urgently if no improvement. No anal gland mass identified on rectal palpation. Assessment: Cardiovascularly stable. Ate a treat during consultation, walking comfortably. Suitable for discharge home with analgesia and anti-emetics. Plan: Diagnostic plan : Bloodwork and physical examination. Owner elected to perform this today. Discharge home with Gabapentin 300mg capsules BID, Paracetamol 375mg PO BID, Maropitant 60mg PO SID. Recheck with regular vet if no improvement or present back to emergency. Owner communication:Informed owners of heart murmur, mild musculoskeletal pain and abdominal pain. Bloodwork largely unremarkable aside from ionised hypercalcaemia and elevated amylase and lipase. Discussed questionable relevance of amylase and lipase but given recent new treats, mild abdominal pain and inappetence - pancreatitis possible. Possible differentials include mild gastroenteritis vs dietary indiscretion vs MSK pain contributing to current presentation. Advised that Ruby should have a recheck for further assessment of heart murmur and for repeat anal gland palpation given ionised hypercalcaemia. If possible, ideally ionised calcium be repeated for monitoring.    Vital Signs    Weight: 28.4;