C09981294 / invoice 10000

Reason: Limping Appointment Notes: Overdue remindersPATIENT:11 years oldWeight: 34.7 kgReason: Right forelimb lamenessHistory:Presented for right front paw lameness over the last couple of days. Owner reports unable to walk down the street, collapses when pain is too severe, unable to put weight on the leg. Vomited two days ago. Collapses after 20-30 minutes of walking. Previous bilateral cruciate ligament surgery with metal plates. Current flea/tick prevention: Simparica Trio monthly.Examination:Vitals:    - Weight: 34.7 kgPhysical Exam:    - General Appearance: Walking on wrist on left side, putting more weight on outside of paw    - Musculoskeletal: Right forelimb - not lifting foot, walking on wrist. Left foreleg  overextended carpus. No palpable abnormalities in distal limb. Nails slightly long but not causing current issues. No pain on palpation of foot or digits.    - Abdomen/GI: Vomiting two days agoASSESSMENT:Suspected arthritis right forelimb (shoulder/elbow region)Differential: muscle or ligament strain (less likely)PLAN:Diagnostic/Treatment Plan: Gabapentin 400mg PO BID x 20 capsules (10 days). If no improvement with gabapentin, may trial meloxicam (blood test recommended prior). Synovan injections discussed as option (4 weekly injections, $71 per injection). Librela discussed as monthly injection option ($135). Weight loss recommended.Recommendations: Restrict exercise for 2-3 weeks, no free running. Short walks only (10 minutes). Multiple short walks preferable to one long walk. Return if no improvement or worsening.    Vital Signs    Weight: 34.7;       

Reason: VaccinationAppointment Notes: Overdue remindersEddu. Bar. All well.    Vital Signs    Weight: 33;       

Reason: Check ElbowAppointment Notes: Overdue remindersPressure sore on the left elbow , indoors mostly but likes to sleep on the floorAlopecia and dermatitis on right elbow , starting on left elbow not as bad Suspeted OA Pressure sore Place doughnut bandage    Vital Signs    Weight: 32.7;