C09973937 / invoice 10000

H: was run into by a dog at the park and was holding the right front leg up  - was run into the shoulder areaThe skin is also flaring up againOwner says struggles in the hind legs, sometimes unsteady, struggles with stairsOwner says sometimes knuckles on paws but is fully blind. Does stumble with stairsE: walking well with the right front - palpate scapula and shoulder region, no obvious fracturespatchy hair loss right shoulder, left chest, lateral thigh both hind legs - hair comes out in clumps - no erythema but when pull out hair it comes our in clumps with black crust at the baseno fluor under uvPain when palpate along the lumbar spine, esp near L/S regionno neck painhips extend well, no painsome crepitus left stiflehocks nadreduce propn hind pawsA: likely skin infection again and trauma right shoulderspinal disease v djd?P; juroclav 250 1 bid 14 daysmetacam 2.5 mg 1 sid with foodrv 2 weeksuse malaseb twice weeklyDiscussed xrays for lumbar spine, hips and stifles

@2pmLMTried to send an SMS too@3pmO called back, advised O of results - doesn't point towards any obvious diseaseO will discuss with partner whether to do further work up (potentially acth stim, or xrays or CT) or just to monitor for nowWill see him back in 2 weeks for the ear infection - can have a chat thenO will monitor clinical signs in the meantime

History:Didn't have appetitte early morning but then ended up eating breakfast anywayEarly morning - quite lethargicSince yesterday evening - PU/PDHas happened before - was associated with skin irritationsSignificant hotspot on right side of body, and has resolved when the skin resolved**Has no spleen!EDDU: No appetite this morning (6am) initially - only drank the water, but then a bit later (9am) did eat. No issues with urination defecation.  PU/PDV+/D+: NoneParasite control: UTDFeeding: Hills science joint careExamine:Behaviour: BAREyes: Blind in both eyes, cloudyEars: Red in left left ear, hasn't been itching at it though - O has been cleaning it regularly.  TM intactNose: NADMouth: NAD  MM pink, CRT <2LN: NADHeart + lungs: Clear on auscultationSkin: NADAbdomen: Soft and comfortable on palpationMSK: Small bump on lateral aspect of distal LHL, ~2cm in diameter + mobile.UA:Normal appeanceBright yellow, mild opacityUSG 1.004Glucose, bilirubin, ketone, blood NEGpH 8.5Protein traceNo sedimentNothing visible on wet or dry prepAssessment:Metabolic disease causing PU/PD vs kidney diseaseOtitis externaTreatment:GEC left ear to remove waxDermotic L ear 0.5ml BID 10dFor PU/PD - nothing for now until bloods are backPlan:RV for ears in 11-14dWill let O know once path results are back