C09984496 / invoice 10000

Reason: Check UpAppointment Notes: Overdue remindersHistory:  O does not want futher diagnostics currently re his HLs but there is still some concern about his gait.He is BAR, running well and not lame on any leg but O thinks he holds up a HL when he jumps into the car- can get in car ok.He has a soft poo intermitently but O gives a variety of extras (chicken, steak) which will give him diarrh. Advised stick with mainly dry food.Is on fluox 20mg sid long term. Rpt script done today.Examine: Tartar gd 1-2,  esp over canines- last dental 18 mths ago.HR 128, anxious but ok to examine.Not limping here but R thigh muscle masss is smaller than L, as noted previously.Reactive on palp along lumbar spine and on pelvic tilt. Not reactive to R stifle palp, no medial buttress, no ant drawer. Patella does not luxate.Assessment:  appears to have lumbar/ lumbosacral discomfort. ? Poss nerve impingement.O can't afford CT or MRI as was advised last yr.She can't remember whether the synovan injs helped him (but did not come back until now and our commment at the 4th inj says he was improved,  so presume they did)Plan: To have another 4 wk course of synovan injs and monitor response.Reassess at the 4th inj and have KC vacc then too.I would recom to have lumbar spine and pelvic XRs when he has another dental as well to investigate as best we can without advanced imaging, which O has declined.    Vital Signs    Weight: 15.3;