C09982431 / invoice 10000

 >Reason: Old dog check>Subjective:-BAR, easy to examine-Gets 6 monthly injections with AVDOS following previous oral melanoma. Managing well on this.-For past couple weeks Beau will take himself outside around dusk and sleep out there until early hours of the morning when he will come back in.-Beau has also been slowing down on walks + occasional stiffness after long rests but no focal lameness evident. Already on Hills mobility diet -O also noted occasional episodes of vagueness/confusion and staring into distance. unsure if this is happening more at night-In past 2-3 weeks O has also noted a couple episodes of defecating inside, almost as if Beau was not aware it was happening or could not get outside in time. Normal texture faeces.-EDUD well, no recent V+ or D+>Objective:MM/CRT/Hydration:  Pink, moist, CRT <2 secRESP/RR:  Normal effortTemp: 38.2, normal anal tone for this GIT/UG: Complaint, non-painful on abdominal palpation Skin/Ears: Coat clean and healthyM/S:  Ambulating well in consult with crepitus on joint manipulation though resistant + mild reduction in ROM on caudal extension of hips bilaterally. Mild muscle wastage of proximal HL bilaterally. Eyes: Bilateral lenticular Dental:  2/4Lymph Nodes: WNLBCS:  6/9>Assessment: -Recent behaviour change: taking self outside at night, DDx: environmental (quite warm/muggy recently) Vs secondary to discomfort Vs Sensory component (possibly a little brighter outside) Vs CCD Vs other -Suspect DJD Vs other underlying joint pathology-Bilateral immature cataracts>Treatment: 50mg carprieve PO BID >Plan:-Noted multiple factors potentially at play. Offered bloods as part of screening, O declined at this stage, will consider if progressing changes. -Offered NSAID trial, O happy to start this today. Noted if comfort improves/signs resolve but recur once medication stopped O to return for recheck. Noted may start longer term OA management at this stage (zydax Vs ongoing gabapentin Vs rehab)-INI of new behaviour on NSAID consider vivitonin trial Vs monitoring as weather cools down    Vital Signs    Weight: 28.3;