C09983339 / invoice 20000

    Vital Signs    

Appointment Notes: CALL CHARU - KAG. rv see how meds are going - bhVET:Dr Liz ClarkeHISTORY-   Presenting complaint: Teleconsult for quality of life disc. Owner was unable to bring Maximus to the clinic due to difficulty with mobility, unable to get him in the car. -   Hx of progressive hindlimb weakness and ataxia, seen 2 weeks ago. Condition has deteriorated significantly since.-   Now non-ambulatory in hindlimbs and unable to rise without assistance. O is always home and can lift him up. -   Poor response to pain relief for suspected arthritis.-   Has developed urinary and fecal incontinence.-   Preventatives: Not discussed-   Diet: Eating normally-   Medications: On pain relief, meloxicam, gaba, panadol, synovan -   Lifestyle: Family pet. Still happy and brightEXAMPhysical examination deferred - telephone consultation.  ASSESSMENTProblems list1.  Progressive non-ambulatory hindlimb paresisDDx: Suspected spinal neurological disease (e.g., degenerative myelopathy, neoplasia). Severe osteoarthritis considered less likely due to lack of response to analgesia and quick deterioration 2. Urinary and fecal incontinence  DDx: Secondary to neurological dysfunction.    Overall assessment: Poor prognosis for return to function. Severely compromised quality of life.OWNER COMMS-   Extensive disc. regarding Maximus's poor and deteriorating quality of life.-   Explained the condition is likely a progressive spinal neurological issue with a poor prognosis and no curative treatment options. Physical therapy is unlikely to be beneficial.-   Disc. that mobility is a key component of canine quality of life and his is severely compromised.-   Disc. humane euthanasia as a kind option to preserve dignity and prevent further suffering. Advised that a "natural" death is often not peaceful for pets and frequently results in an emergency situation. O is struggling with the concept of 'taking his life' when he is still happy and eating etc, O does not mind cleaning up soiled blankets etc -   Advised the timeframe for this decision is likely days-weeks, not months.-   Suggested a mobility assist harness could help with lifting in the short term.-   Mentioned at-home euthanasia services are an option.-   Owner advised of teleconsult fee, reception will call for payment PLAN-   Owner to monitor quality of life closely.-   Owner to consider timing for humane euthanasia.-   Owner to contact clinic for further advice or to arrange medication dispensing - ok to dispense more if within 4-6 weeks, but if any longer we probs need progress exam to assess quality of life     Vital Signs