C09982939 / invoice 10000

Reason: Worse After Visit On SundayHx: Was much better on Sunday afternoon (after she had the methadone injection) but yesterday she was getting worse again. Today she is even more sore. She gets distressed when separated from her brother so he has bawled her over since Sunday once or twice.Ex: Is still quite sensitive on palp of the mid spine (near T-L junction), no worse than it was on Sunday though. Neck movements and tail jack NAD. Corrects knuckling in both hinds.Discussion/Plan: I've given another methadone injection, going home with codeine for extra pain relief. I've also dispensed trazodone for her anxiety if they are struggling to keep her quiet. She will need separation from him I think as she is at high risk of re-injury. I've asked them to call tomorrow with an update about her.Tx: 0.8mL methadone SC, starting tonight from 5pm - 30mg q8-12hrs prn, 8-12 doses trazodone (100-150mg q8-12hrs).    Vital Signs    

Reason: In Pain? YelpingHx: Today has been very uncomfortable/unsettled. Yelping out in pain randomly. Not able to jump up on furniture despite wanting to. Not had these issues before.Ex: Put paw up on chair in consult but not able to get herself up onto it (O says that this is very unusual for her). NAD on neck movements, NAD on tail jack. I suspect uncomfortable around T-L junction on palp of spine (repeatable). Abdo palp: NAD, MM pink, heart NAD.Discussion/Plan: I suspect back pain (IVDD?). I have given her methadone for now, gaba can start tonight, carprofen when she gets home (can have with food). Recommended resting for at least a week (no deliberate walks). INI each day = revisit.Tx: 0.8mL methadone SC, 10 days carprofen (75mg SID), starting tonight - 7 days gabapentin (300mg BID).    Vital Signs    Weight: 27.5;