C09982673 / invoice 10000

Check IVC - Placed LFL Patent se

HISTORY: NQR
- couldn't get on to the bed this morning 
- moving in slow motion
- usually very jumpy and active even at vet clinic 
- was shivering in waiting room 
- all started this morning 
- O children have noticed pt has had moments when she's slow going on for couple of weeks 
- green poo once, sloppy poos to well formed faeces
- 1-2 months ago, back end looked collapsed, but was okay 
- appetite has been off since yesterday
- unsure what toileting has been today as they have doggy door
- has noticed some knuckling in back feet 

EXAM:
Mentation: BAR (O notes usually way more hyperactive) 
MM pi CRT<2
HR 120 nad
RR 36 clear bv sounds 
abdo palp tense 
BCS 6/9
Rectal fully formed faeces
temp 40.2 
MSK: ambulatory on all 4, no signs of knuckling in consult, buckling on lumbar palpation at level of T13/L1, no neck pain 
Neuro: 
- no cranial nerve deficits present, menace intact.
- Mild ataxia in back legs, hips swaying exaggerated when walking
- Paw correction in left HL paw delayed > right, Paw placement hopping delayed in both legs 
- subjectively withdrawal and patella reflex on left is reduced 
LNS wnl 

CBC
WBC 18.57 x10^9/L 5.05 - 16.76 HIGH
NEU * 14.22 x10^9/L 2.95 - 11.64 HIGH - BAND * Suspected
Biochem 
CRP >>100mg/L HIGH

ASSESSMENT:
Fever + spinal pain + neurological deficits 
ddx. MUO vs primary IVDD + FUO vs other 
Paraparesis
ddx. MUO vs IVDD vs other spinal cause 


PLAN:
Offered:
1) hospitalisation 2-3 days, diagnostics 
2) Home with supportive care

O opted for 1

Updated options offered following hospitalisation and diagnostics 
1) Referral for neuro work up with CT/MRI + CSF tap 
2) CSP tap in house and treat presumptively for MUO

O opted for 1

MEDICATION:
Pain relief provided: Buprenorphine IV 0.02mg/kg = 0.83ml IV~ 11:20am 
Hartmanns at maintenance = 31.25ml/hr 

COMMUNICATION:
Following admission and diagnostics, adv O that CT/MRI and spinal tap would give us a much more thorough diagnostic of what is going on. Disc poss muo vs fuo + ivdd or other causes, but would like to rule out muo due to presentation. 
Disc potential costs at referral would exceed $5000. O has pet insurance and happy to proceed with referring. 

HISTORY:
Presented for: Cons: Blood in urine, frequent urination, possible UTI
noticed tiny bit of blood in urine 6 weeks ago
becoming more blood, and having hard time controlling peeing
drinking a lot and peeing a lot
still eating well
on apoquel, wanting more dispensed

EXAM:
Mentation: BAR
BCS: 6/9
Hydration status: euhydrated
Eyes, Ears, Nose: NAD
MM: pink moist crt <2
LNs: poss. slightly enlarged popliteal LNs
CV: HR: 120bpm, no m/a
Resp: URT sound, normal effort and bv sounds
Abdo: soft comfortable
MSK: amb x4, no lameness/ataxia
Integ: NAD
Neuro: no obvious deficit
T: 39.1

ASSESSMENT:
ddx: uti vs cystitis vs kidney disease

PLAN:
went outside and attempted to collect free catch during consult but was unsuccessful
offered to drop off urine sample later for analysis or blind treatment (risks with abx resistance and poor abx stewardship explained)
advised potential kidney or metabolic disease with PUPD, will recheck after finishing abx
O opted to go home with abx
apoquel dispensed

COMMUNICATION:
as above