C09978289 / invoice 10000

Reason: Limping, Lethargic And Off His Food Appointment Notes: O called and said that the dog has gone down hill. Was seen at MA yesterday. O very concerned to happy to come to CD for the 10am. She didnt want to wait to go to MA at 11am.History: This am normally very energetic to go outside but this morning had no want and laid on one place. Back right is limping and not fully WB on it. Seemed WB in consut Been 'stiff' For about 2-3 weeks. Say yesterday and adv could have sore back but hesitated to give NSAID as D+ a little bit pst weekOwner has video of limping, shows left limping but he flinches when touching rHS, normally jumps up at people but not doing that today.Reduced appetite. Still eating when coaxed No v+ or d+No hx of trauma No coatal trips Currently on apoquel for skin. Decent response Examination:BAR MM pink and moist Vitals wnlChest clearAbdo okLN nad MSK:- Pain on palpation RHL lateral digit (P5). Localised over proximal phalange/metatarsal joint - Mild swelling - No wounds or trauma Integument nad Radiographs:- No obvious fractures of breaks- Swelling of P5 RHL ******* CLIENT EXPECTATION following RN radiograph review *******Please delete those not applicable, or otherwise highlight preferred communication.* SAME DAY call* call by NEXT DAY* call by CONSULTING VET when next on duty* call ONLY IF NEW INFORMATION TO REPORT (ASAP if urgent - leave with CONSULTING vet if not)* NO NEED to call If nothing is marked (unless URGENT) a message will be left with the CONSULTING VET when next rostered.Surgery/Procedure Admission Consent FormHas your pet eaten in the last 12 hours?: YesI would like my pet to have a pre-anaesthetic blood test.: YesDo you consent to your pet getting an ear tattoo?: Not applicableProcedure details : X raysPhone: 0419 011 161Is this the preferred contact number? If not, please complete below: YesEstimate : $700-800View full form at https://api.vetcheck.it/share/AU_3612048f-03d7-4b40-b7c9-7f3233073d7cVerified: NoReason: Limping and lethargic, off foodHistory:Limping and lethargy for couple of daysOff food this morning, required hand feedingUsually excited to get out, today reluctant to moveBeen stiff for couple of weeks, thought might be sore back6 years old, turned 6 in JunePrevious sore back from rough play with brotherRecent nose irritation, shaved and given cream, resolvedSlight diarrhoea yesterdayNo change in diet - Lyka salmon roll and salmon kibbleNo known traumaCurrent medication: Apoquel for skin conditionExamination:BAR in consultMMs: pink & moist, CRT < 2secDental: Grade 3-4 dental dz, multiple abscesses, purulent dischargeEars: No odour or significant dischargeNose/Throat: Sneezing, purulent discharge possibly from dental dzCardio: no murmur or arrythmiaResp: Lung sounds clear, normal respiratory effortAbdo: comfortable on palpation, no palpable massesMSK: R hind limb lameness, reluctant to bear weight, swollen R digit, painful on palpation of R stifle and digitMasses: Small cyst on nose - aspirated, fluid obtainedIntegument: NADLNs: normalLaboratory:BIOCHEMISTRY: ALP 2800 (ref <200), ALT 400-500 (elevated 5x normal)FNA: Cyst - fluid aspiratedAssessment:R hind digit injury - possible chip fractureSevere dental dz with abscessesElevated liver enzymes - suspicious of Cushing's dz (hyperadrenocorticism)Plan:Cyst aspiration performedAntibiotics dispensed - half tablet BID with or without food for 1 weekAnti-inflammatory dispensed - half tablet BID with food for 1 weekRadiographs of R digit recommended but declined due to anaesthetic risk with elevated liver enzymesConversation with owner:Owner declined radiographs due to concerns about anaesthetic riskDiscussed elevated liver enzymes and suspicion of Cushing's dzRecommended abdominal ultrasound at Mount Annan on Thursday ($750) to assess adrenal glands and liver before considering dental procedure under anaestheticAdvised to stop anti-inflammatory if V+ or diarrhoea occursAntibiotics may cause diarrhoea but less likely than anti-inflammatoryDental procedure estimated $2000-3000, may require stagingREX in 1 week to assess response to treatmentUltrasound appointment can be booked for Thursday at Mount Annan - drop off 9AM52% PCV Clear - VKR    Vital Signs