C09972963 / invoice 10000

Reason: Follow Up On Limp - RBAppointment Notes: Overdue remindersHistory:3-4 months since last visit with JN:Has been going ok but last 6 weeks start limping with the back leg which in the past due to lumbar painRecheck of LF lamenessNotes from last few visits:Continue cartrophen monthlyFish oil 4cyteGabapentin bid  for 4 weeks if responding well ok to do pxPrevicox on hand for flare ups of painONCE WARMED UP IS SOUNDGABPENTIN AND PREVICOX DOESNT MAKE THE LAMESS DISAPPEARSuspect digit DJD of sesamiods is unlikely to imprvoe , discussed sx at VSS or intralesionmal steroidsGabapentin certainly helped with lumbar spine pain so continue with 300mg bid px doneFeb 5 days of previcoxWas limping LHThen Feb 14th was limping LH and LFThen 27th Feb limping LH again (previously seen at VSS for Lumbosacral disease and nerve root impingement) When on previcox is a happier dogNo change in exercise recentlyStill on gabapentin 300mg bid Discussed hydrotherapy Once up and walking, and is warm walks fine and still walking twice a day Examine:COAT/SKIN: no abnormality detectedEYES/EARS: no abnormality detected, ears and eyes clean and clearMOUTH/TEETH: Oral exam normal, no mouth pain, dental score:1HEART: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousLUNGS: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeABDOMEN/DIGESTIVE/URINARY: no abnormality on palpationCNS/MUSCULOSKELETAL: normal palpebrals and menace bilaterally; ambulating normally, right carpus reduced ROM compared to left, left elbow sore on full extension, mild reaction right elbow, mild reactivity lumbar spine palpation, lefty hip not keen to extend, left stifle maybe a little thickened compared rto right, left stifle feels table, no TT in consult  no palpable neck pain, spine, limb, joint painPeripheral Lymph Nodes: no abnormality on palpationWEIGHT/DIET: Body Condition Score:4/9REPRODUCTIVE: no significant abnormalitiesOther:Worming/Heartworm/Flea control status:UTDNutrition:Laboratory:  Differential Diagnosis:IVDD + DJD + sesamoiditis Plan:Trial gabapentin at 8 hours if doing better consider swapping to pregabalinConsider beransaDiscussed ketamine Discussed repeating rads of front feet, elbows, lumbar spine and hips and stiflesPlan:Onto previcox 227mg for 2 weeksGabapentin tid for 2 weeks Continue cartrophenIf improves then:Change to pregabalin bidConsider ketamineBeransa (will hold off for now due to suspect Lumbosacral disease) If not much better consider repeat radsGap Only Summary:Pet Primary Diagnosis/Suspected Diagnosis/Location:limping Suspect cause:arthritisAny other conditions being treated (if any):nilKnown health concerns:nilDate of first clinical signs (if known):ongoing    Vital Signs    Weight: 29.9;