C09984572 / invoice 10000

H: Has been diagnosed by GAR with bilateral juvenile cruciate disease.Booked for surgery in the new year - O needs to put together the money.O would like more pain medication - gabapentin and meloxicam.Fear aggressive especially with males.Best not to approach as per OE: BAR in consultWagging tail and taking treats.Unable to examine as per OA: Bilateral cruciate diseaseP: Dispensed gabapentin and meloxicamO to get surgery done in the new year.28/11 POC no ncb mc

Problem List:Bilateral stifle swelling with pain and discomfort on flexion and extension (conscious examination) Ddx. bilateral cranial cruciate ligament disease (partial or complete rupture), meniscal injury,degenerative osteoarthritis, OCD >> hip dysplasia >> spinal cord compressionRadiographs at rDVM on 19/11 showed bilateral joint effusion (L > R) with reduced infrapatellar fat pad, marked sclerosis of the femoral head and neck, osteophyte formation to the distal aspect of the patella, no evidence of OCD lesionsElevated CRP at rDVM on the 19/11Ddx. non-specific acute inflammatory marker for caninesPlanPlanCola to be discharged today with the plan of a surgical consultation with RC in the morning tomorrow (booked for 10.30am, no charge for the consultation)Discuss options moving forward (surgical and conservative)Meloxicam 0.1mg/kg PO SID tonight (owner has at home)Owner to keep her calm and confined, no exercise until the morningNo breakfast in the morning in case of surgical procedureOwner happy with the plan and appreciative

Verified: YesHISTORYPresenting for: Canine patient presented for inability to use both hind legs, requiring sling assistance with Owner last night.Did go walking yesterday and had more of a run however has noticed some weakness in hind end prior to thisGenerally finds that 1 hour is a maximum walk recentlyVery aggressive dog unable to examine but is ambulating in consult room although stiff in hind legs - hyperextended? and seems weak in hind end. Not obv knuckling but hard to assess.Video sent from owner later in the morning - sling used, dragging and knuckling both hind feet.EXAMMentation: AggressiveWt: 22kgRectal temp (once sedated) - 38.6 degrees CDiagnostics: - Pre general anaesthetic bloods unremarkable- CRP: 25.1- Radiographs showed bilateral stifle effusion, no evidence of cranial drawer under sedation, no evidence of spinal pathology, patellas not luxating- More advanced imaging required to assess for disc protrusion/extrusion impinging on spinal cord +/- Joint tap if suspect polyarthritisLink for xrays:https://app.signalpet.com/ng/studies/6818267?visitor_mode=true&flow_id=17116672&visitor_link_token=vb1O5C1OUSVFUyuZYLZRBUnnLYRRuEppASSESSMENTBilateral hind limb paresis - DDx: spinal cord compression from disc protrusion/extrusion vs polyarthritisBilateral stifle effusion - No evidence of cranial drawer under sedation- open growth plates vs fracture of ilium (see lateral xray) and tibial crest (bilaterally)PLANMedications/Treatments:- Sedation administered for radiographs: 0.6mL Torbugesic, 0.25mL Ketamine, 0.2mL Medetomidine IM which provided good sedation- Additional top-ups of alfaxalone required during radiographsDiagnostics:- Advanced imaging (MRI/CT) recommended to evaluate for disc protrusion/extrusion impinging on spinal cord causing bilateral knuckling of hind legs- Have called GARS and they have some surgical spots open today, will look at straight referral for further work up.- Awaiting call back from owner to confirm she is happy with referralDischarge:- O. concerned re cost at referral so will look at starting with CT hopefully to make diagnosis and see if NSAID or steroid dosing is possible over surgery. Will require estimate and preapproval to be done with insurance.- Did offer strict rest and high doses of steroids as an alternative due to cost concerns. O. would rather go to referral.20/11 - No ncb client went to GARS last night and has a recheck booked with them this morning. mc