C09973180 / invoice 10000

Reason: Calm care admit for x-raysAppointment Notes: nmSubjective: Last day carprieve today and have not noted any real change (had also had course of meloxicam with no differenceOnly thing changes is not noting the whimpering, crying but still not jumpingOnce jumped on the chair, but the only timeOne whimper when on a slope and crouching in sitting positionNo more overt lameness of right fore but does always lie with this foreleg tucked under Main issue is not getting up on bed, all started with the incident of going off the balconey chasing a toy.No videos as not anything to see.Felt last night after gaba and traz and was very unsettled, did not sleep well, up  and downObjective: Given meth 0.6 and 0.12 domitorTake bloods, fat in biochem, so send offFbe all goodTake xrays of lower spine, hips, neck and stifles Stifles and hips seem fine, maybe mild shallow of the left hip Mid lumbar spacing marginally narrower but no sign of spondylitis or boney changeNeck hard to evaluateShoulders and elbow seem finePlan: Options, ongoing rest for one more month , gabapentin for neuropathic painSince fine otherwise, rest and monitorReview one monthNotice severe dental disease and halitosis, rang to get approval to upgrade to dental est extra $500-800Alfaxan iv and fluidsDescale very heavy tartar and gingivitis, descale, teeth all sound but with the gum disease would have needed extractions if ongoingPolish and fluoride treatment    Vital Signs    

Reason: Gaba Appointment Notes: For calm care monday can we also add instructions on traz (mrs has at home) and steps to giving night before and morning of  - mv mvGabapentin 100mg po the night before and 2h before admitTrazodone 50mg po the night before and 2h before admit  (o has trazodone at home)    Vital Signs