C09978430 / invoice 20000

Appointment Notes: HL Radiographs. GAP only claimEstimate: $575 + 245 bloodsMedications: Paracetamol & Gabapentin approx 7:30amFasted: YesDoes your pet have any food allergies or requirements? nilPAI bloods: YESExtras: NilContact: Helen 0418265206 (available after 12:30pm)KEEmla applied on arrival Pre-med exam:   BAR - very nervousHR 124bpm; soft grade 1 murmur not always audible but can auscultate over P/M valves of LHS only, regular rhythmLung fields OKOral OK some teeth missing from prev extractionsGrade 4 lame LHL, pain on forced extension of stifle, reluctance to extend hip, + cranial drawer and TT. Tibia clunk as slipping off slope. Patellas in place. Tight hip abductors L > R. distal limb WNR. Pre-sedation bloods all WNLIV catheter placed,  Sedate with 0.35mls butorphanol IVClient communications:GI phoned and spoke to Helen - advised of heart murmur on exam this morning. Offered to do chest rads vs just hip/stifle today. O declined chest rads today just wants to focus on knees.Will further discuss echo / chest rads on discharge, especially if looking to sx for stifle dz.Procedure:1ml alfaxalone IV required to facilitate radiographs Lateral pelvis and stifle views VD hip viewsAP stifle viewsIncreased soft tissue opacity in stifles bilaterally, L >> REffusion in both stiflesAssessment: CrCL tear L, suspect strain vs low grade tear RNEW soft cardiac murmurPlan:Recommend consult with EB for bilaterally stifle dz, but L CrCL ruptureRecommend "mini echo" in house with JR $750 vs VN echo $1,100 vs TPS cardiology $1,100-$1,300Continue paracetamol + gabapentin, start meloxicam aswell tonight.03/03/2026 10:30:06 AM GI:GI phoned Helen no answer.03/03/2026 1:12:58 PM GI:Helen phoned back - GI gave verbal d/c. ADvised PE and rads confirm L CrCL rupture. Advised also some concern for the right leg, may not have torn yet but suspect strain and increased chance of rupture in the future. Recommend consult with Dr EB, can organise for mobile consult here. Mrs says she will have to check what days work for Mr and get back to us.Spoke again about heart workup up - have put options in detail on d/c letter but advised can do at GP level vs specialist. Soft murmur so unlikely to need meds at this stage but gold standard to check especially before GA for TPLO. O understands. WIll consider options and speak to Mr,03/03/2026 12:37:27 PM VY:Post sed TPRMentation: BAR, nervous RR: 28HR: 108MM: Pink, did not attempt to palpate mm as bites Temp: 38.5cEDUD: taken out for a walk, no U or D. Fed i/d, not interested IVC out     Vital Signs    Weight: 12.4;       

Appointment Reason: Limping, Appointment Notes: Jumped of chair - limpingHistory:Yesterday jumped off the bed and was non-weight bearingWent to NEVS last night and they started him on gabapentin and paracetamol - O reports seems to have made him more comfortable todayEDUD all OKNo V+ or D+Examine:BAR - extremely nervousHR 124bpm; regular rhythm, no murmur on auscultationLung fields OKToe touching lame on LHL, resents stifle flexion Limited PE as patient resents handlingAssessment:Suspect L CrCL tear Recommend sedate and radiograph vs continue pain relief and restO elects to proceed with radiographs tomorrow - advised likely to need sx consult with EBBriefly discussed sx but did not want to overwhelm before we have more information from radiographs tomorrowAdvised if TPLO can be performed here by mobile specialist, if more involved procedure may need to be performed at TPSPlan:Booked in for sedate + rads tomorrowContinue meds tonight, hold off tomorrow morning as fasting for procedure02/03/2026 6:39:18 PM RM:Will pay tomorrow as we can put through a GAP for today and the x-rays tomorrow bx    Vital Signs    Weight: 12.2;