C09973335 / invoice 10000

19/02/2026 Hx 
- for the past week has been passing stools in the crate . sometimes formed, sometimes softer.
- has been crate trained, and tolerated this well before until just this last week 
- urinated in the house the other day for this first time. Always been very toilet trained. no signs  of incontinence
- V+ once yesterday, bile stained . no further V+ since then, eaten well and kept this down 
- had a chill pill today 
- chews on rocks, o thinks however doesn't swallow them? They have since prevented her access to this area 
- held off on nsaids, also didn't want to cause further GIT issues 
- is stiff including on hindlimbs  , o thinks Forelimbs now improved but now more affecting hindlimbs, not overtly lame but sometimes stiff to rise  (refer to previous diagnosed panosteitis, had been noted in both FLs and HLs on rads) 
- Is more mouthy than before, always been this way but getting worse 
- Normal diet is - Advance puppy tins and R/C lab pellets.   no recent change  
- appetite okay
- no known toxin exposure/ or FB ingestion 
- up to date with intestinal/flea/tick/HW prevention -->  Nexgard spectra

PE 
distracted with liver treats 
didn't bite but Is mouthy ***
BAR
MM pink, CRT 1 sec
Eyes/ Ears: NAD
Teeth: NAD
LNs: NAD 
Chest: NAD, normal heart/lung sounds. 
Abdo: NAD, soft and comfortable 
Skin: all normal
Musculoskeletal: 
normal mobility in consult however dislikes manipulation /palpation long bones forelimbs/ hindlimbs. Difficult to localise further as becoming increasingly mouthy, suspected exacerbate by underlying pain 
no back pain noted 
rectal, AGs NAD, no stools on glove 
Temp 38.5C

Assessment 
- previous diagnosis of panosteitis , affecting FLs and HLs 
-  previously noted hypoglobulinaemia. 
- defecating now in crate overnight on and off, sometimes formed sometimes soft , seems more unsettled now overnight 
- urinated once in house, not again ( territorial marking?) No incontiinence, no other signs noted. 
- more reactive now than before, suspect secondary to pain

Plan
Bloods submitted for TAHP to recheck globulins ( refer to previous notes). Bloods taken R lateral saphenous, whilst o feeding liver treats, worked well. Note left for vet to call tomorrow with results 
Commence on prokolin, INI consider faecal testing 
Suspect however intermittent colitis/ unsettled overnight/ behavioural changes/ mouthing/ lameness also likely secondary to pain. R
commence paracetamol 500mg PO BID daily. When D+ resolves, add in Meloxicam ( if recurs , then stop) 
Consider adding in anxiolytics if worsening behaviour  
Regular meal times,  toilet after, walks if comfort levels ok, maintain routine 
Discussed re some issues may also be hormonal related, ideally wait desex 12 - 18 months of age and once all signs of panosteitis have resolved 
Will follow up for further update next week, o to contact sooner INI or any other signs ( ie V+, appetite change etc)

21/02/2026 Globulin 24 (25 - 45 g/L) L
Total Protein 58 (52 - 80 g/L)
Albumin 34 (23 - 40 g/L)

NH called O to discuss blood results, no answer, l/m requesting O to call back.