C09973567 / invoice 10000

Appointment Reason: 1.3 CONSULT 3, Appointment Notes: 2P rads under sedation hips and stifles RHL lame AN ------- Sms reply: YIn  for sedated xrays of hips and stifles following a 2 week history of intermittent RH lameness. Unable to obtain bloods conscious - given 400mg gabapentin PO, still not sufficient so premedicated with 0.4mg/kg butorphanol IM.Bloods obtained. No significant changes. Sedated with 20mcg/kg medetomidine. Insufficient sedation so IV placed and given 2mg/kg alfaxan to effect.  No cruciate drawer in either limb, no crepitus, but slight thickening on medial aspect of R stifle. No otolani sign either. 2 x lateral and CCs of stifles taken and lateral and VD of pelvis. No stifle effusion present, however slight loss of opacity on medullary cortex in R distal stifle compared to L. Good hip coverage. Ddx - suspect panosteitis - maybe repeat xray in 3 - 4 weeks to reassess as lesions may be more evident then. Usually self limiting so treatment involves pain management as needed. TSB rang O, discussed xrays and suspicion of panosteitis,  however changes on xrays are very subtle so if still very lame have recommended repeating xrays in 3 - 4 weeks, but until then continue to use loxicom SID as needed. O thinks she has half a bottle left - advised can dispense more if needed, otherwise when O finds new vet we can send history through.     Vital Signs    Weight: 25.6;       

.Vet: Dr Andrew Neutze, BVSc MVetSci  REASON FOR VISIT    Presenting Concerns:-   Ghost presented for a RH lameness that has been present intermittently for the last 2 weeks.-   The lameness varies in severity; on some days it is not apparent, while at other times he will hold the leg up completely.-   The owner reports that the condition has not been getting progressively better or worse.  Other concerns:-   The owner has noticed an increase in licking of all feet recently. She had previously seen what appeared to be bug bites on the feet, but these seem to have resolved.  Historical Conditions:-   There is a history of a previous injury to a front leg, which resolved with rest and anti-inflammatory medication.-   There is no history of any issues with the hind limbs.  EDDU:    Lifestyle Risk Factors:-   The owner reports that Ghost frequently jumps off stairs.-   The owner is moving to the Sunshine Coast on Tuesday.  Vaccination Status:    Current Medications:-   The owner has leftover liquid meloxicam from a previous injury but has not administered it for the current problem.PHYSICAL EXAMWeight: 26 kg  Mentation: Bright, alert, and responsive  T: Not taken, HR: 108, RR: -, MM: pink/moist. CRT < 2sec., BCS: /9  -   EYES: No abnormal findings-   EARS: No abnormal findings-   NOSE: No abnormal findings-   ORAL / DENTAL: Dental score: 0/4-   HEART SOUNDS: No murmurs or arrhythmias-   RESPIRATORY: Normal bronchovesicular sounds bilaterally.-   ABDOMINAL: No organomegaly or mass effects. No pain on palpation.-   EXTERNAL LN: No abnormal findings-   UROGENITAL: No abnormal findings-   RECTAL: Not performed.-   SKIN AND COAT: No abnormal findings. No lumps noted.-   MUSCULOSKELETAL AND GAIT: A significant RH lameness was observed. Palpation revealed soreness in the right hip and stifle regions. There is mild swelling noted around the right stifle, and soreness in the associated hip flexors. No obvious cranial drawer was detected on manipulation, but a partial cruciate ligament tear cannot be ruled out.-   NEUROLOGIC: Normal mentation, no ataxia.  DIAGNOSTICSASSESSMENTRH lameness – DDx: Partial cranial cruciate ligament tear, hip dysplasia, soft tissue injury (sprain/strain), panosteitis. The lameness has been present for 2 weeks without improvement. Physical examination findings of pain localised to the hip and stifle, in conjunction with the patient's breed (German Shepherd), make hip dysplasia and a partial cruciate tear key differentials that require further investigation.PLANDiagnostics pending:-   Radiographs of the hips and stifles are recommended to investigate the cause of the lameness.-   The procedure has been tentatively booked for Monday. The owner was instructed to fast Ghost from the night before and bring him in for admission at 7:30 AM.-   A rough cost estimate of $900 was provided for the diagnostic imaging. However O understands formal estimate will be emailed to the owner for review.  Medications/Treatments:-   It was recommended to start the leftover liquid meloxicam. The owner was advised to administer the dose appropriate for the patient's current weight of 26 kg, as per the markings on the syringe.  Additional Discussion:-   The owner confirmed the patient is covered by pet insurance.-   The owner is moving to the Sunshine Coast on Tuesday. It was discussed that if surgery is required, it may need to be performed at another clinic, though the owner indicated a willingness to travel back if necessary.-   The owner was advised to call to confirm or alter the booking for Monday after she has reviewed the formal estimate.  This document was generated with the assistance of CoVet AI to support accurate and efficient documentation.    Vital Signs    

History:EDDU well at home. Due for  vaccination. No concerns.Examination:BCS: 5/9Hydration status: Euhydrated. Normal skin tent.MM: pink and moist, CRT<2s.Temperature: NTCardiac: regularly regular. No murmur or arrhythymia. SSFA. Normal pulseRespiratory: Clear BVS bilaterally. Normal effort. No crackles or wheezeNeuro: Normal mentation. Not fully assessedEyes: NADEars: NADNares: NADOral: C1/G1. Normal occlusion.Lymph nodes: All peripherally normalAbdomen palpation:Integument:MSK: Ambulating well. Hip has normal ROM. spinal palpation NADGenital: Entire. Moderate enlargement of glands near the base of penis. No discharge. O reported there is no abnormalities in his urinationAssessment:Okay to vaccinateTreatment:C4 S/C 5257036ABB ORAL 5245048APlan:Revisit in a year time for annual vaccination.    Vital Signs