C09972091 / invoice 10000

Reason: Lethargic, NQRConsultation Time: 0015History: Today has not wanted to stand up and has been sleeping the whole dayThis evening noticed that her back legs seemed a bit weakHas a lipoma (tested with RV) in the R inguinal region which is very large in szie and has recently became firmStill EDDU normally when food was brought up to herNo V+ or D+No known traumatic eventsNo other dogs at homePimobendan for heart murmurLikely has arthritisKnown urinary incontinence and chronic dry coughSubjective: QARObjective: Temp: 39.3BCS: 5/9     Wt: 11.8kg Pain Score (CSU): 0/4MM: Pink, moist    CRT: <2HR: 120     FP: Strong, synchronous      RR: PantingCV: Grade V/VI heart murmur audible; no arrhythmias auscultated       RESP: Normal effort and pattern, normal bronchovesicular sounds in all lung fields       GIT: Soft and pliable on palpation, no abnormalities detectedU/G: Bladder not palpableNeuro: Normal mentation & posture; no ataxia; menace & palpebral reflexes normal; PLRs intact direct & consensual; CPs intact in all limbsM/S: Ambulatory on all four limbs, no lameness although stiff gait in HLs; no spinal or long bone pain; no crepitusInteg: ~10-15cm subcutaneous growth in right inguinal regionOphth: Pupils equal and visible, no discharge notedLNs: No peripheral lymphadenopathy appreciatedProblem List:Unable to walk or stand up at homeLarge lipoma in R inguinal regionOther comorbiditiesAssessment: Reduced mobility and stiff gait likely multi-factorial including the lipoma and possibly arthritis. Can consider starting empirical arthritis management and assess response. FBE to screen for underlying disease may be worthwhile as well given the patient's age. Debulking of the lipoma may not be the most feasible option given the patient's age and comorbidities.Reasonable to monitor at home and reassess with RV given the patient is otherwise well with no signs of pain.O comfortable with the plan and will follow up with RV.Treatment:NILPlan:As above.    Vital Signs