C09983279 / invoice 10000

Appointment Notes: sore toe HISTORYPresenting for: Greyhound presented for arthritis injection and nail trimming. Owner reports episodes of acute screaming, particularly when turning and stopping suddenly.Historical Conditions: Broken digit approximately 2 years ago (July/August 2022), treated by colleague. Previous sensitivity to carprofen causing diarrhoea.Current Meds: Currently on medication for some time (specific details unclear from transcript).EXAMBehavioural: Patient exhibited extreme vocalisation during examination - described as greyhound scream occurring 12 times, described as sounding like someone sticking a dagger in his mouth.Musculoskeletal: No reaction to range of motion testing. No palpable swelling detected. Normal range of motion when performed slowly. Pain appears to be triggered by sudden movements or tweaking in certain directions rather than slow, controlled movements.Integumentary: Overgrown nails noted, one nail caught.ASSESSMENTChronic pain episodes - likely musculoskeletal origin related to sudden movements, particularly turning and stopping. Pain not reproducible on controlled examination but triggered by acute directional changes.Overgrown nails requiring trimming.PLANMedications/Treatments:- Arthritis injection administered today for anti-inflammatory properties- Nail trimming performed- Gabapentin prescribed for pain relief- Antinol (omega-3 supplement) prescribed as additional anti-inflammatory support- Carprofen avoided due to previous gastrointestinal sensitivityDiagnostics:- CT scan of both forelimbs discussed as gold standard for comprehensive evaluation of bones, muscles, tendons and ligaments if episodes continue. Would provide direct comparison between limbs and detailed soft tissue assessment. X-rays noted to have limited sensitivity for soft tissue changes in greyhounds due to thin limb structure.Additional Discussion:- Monitor response to arthritis injection and pain relief medications- If screaming episodes resolve, patient can continue current activity level- Patient currently stable, fit and healthy aside from pain episodes- CT imaging recommended if conservative management unsuccessful—Reason:—Subjective:—Objective: HR/PR/CV: XX, no murmur, matching MM/CRT/Hydration: pink moist, <2, adequate RESP/RR: no wheezing or cracklesGIT/UG: abdominal palpation comfortable and unremarkable Skin/Ears: NAD M/S:  NAD Eyes: NAD Dental: G Lymph Nodes: WNLBCS: 5/9—Assessment:—Treatment:—Plan: ________________________INSURANCE HXInitial Assessment > sore toe/leg Suspected cause > strain Vs pulled muscle vs OA Date of first clinical signs >4/3/26Any other conditions / treatments > no    Vital Signs