C09975139 / invoice 10000

O reports mid last year - had an incident at groomer. since then, HL not working properly. Slowly getting a bit worseWe have seen him twice in the time span. Did some meloxicam, nothing ongoing.O reports seems happy front half of body, Back half not working properlyHas pressure sores on hind feet LH worse than RH. O just managing by putting on very rudimentary bandagesExam:BARMSK - Front legs completely fine.HL - Partially paralysed. Can still sort of get up and half stand with HL extended. Tries to move HL but moving Pelvis side to side. No actual motion in HL. Pressure sores - LH worse - dorsal aspect several pressure sores dorsal aspect of distal metatarsals and MTP. pink tissue exposed. Not overly weeping. RH - mild pressure sore medial MTP jointAdvised Likely spinal issue - DDx: IVDD vs. neoplasia vs. other. O not going to pursue Sx or any intensiver interventionIs open to trying acupuncture. Will try weekly for 3-4 weeks to see if we see any difference.Tolerated acupuncture better with nurse holding. Did put E-collar on just in case he was going to bite but didn't really do anything with it on. Just didn't sit the stillestcould not do many back points today as not sitting stillYBH, GB 30, BL 40/60, GB 34With pressure sores - advised cleaning BID, E-collar to stop licking. Avoid areas where he runs and scrapes hind feet (Eg. concrete/hard flooring) Ideally leave open to air.Discussed briefly harnesses/wheelchair to help with mobility as well

Presented for the revisit. Seemed to be helping much more with meloxicam vs gabapentin. O would like to continue with meloxicam at this stage. Did have a vomit recently, but this is normal for him and nothing unusual, one off. Has been passing normal feces, no blood in it, no diarrhoea, formed.E:BAR, very anxious in consultHR 120, no audible mrumurRR panting, clear BV sounds MSK - Very stiff RHL on exam today, unable to benmd stifles, dragging, No CP but pain perception is present. Unable to extend R hip sits with RH straight out. LHL, slightly more mealleable with bending, very mild, swelling on the L stifle, Severe muscle atrophy on the HLs, Unable to flex R hip. Anal tone and tail tone still present.BCS - 2/5,A:High suspicion of nerve involvement with neuropathy and muscle atropy. Could not r/o potential fractures from the fall previously unless more investigation done.P:1) Discuss investigation - only medication for today2) Discuss NSAID and kidney involvement. O just wants to keep him comfortable for now. 

Dispense meloxicom (4 days worth as overdue for visit with vet) - Please give 0.5mL orally ONCE daily WITH FOOD ongoing. If suddenly unwell/ vomit/ diarrhoea, stop and contact vet.