C09985442 / invoice 10000

Reason: Stiff In The Back Legs Appointment Notes: EP  ------- Sms reply: YesMaggie (7yo, Female Spayed, Cavalier King Charles Spaniel)Record Entered by: Vet student Jared Jenner   Record Checked by: AW   BIOSECURITY STATUS: Blue (not up to date with lepto)   PRESENTING COMPLAINT:Maggie is a 7 year old female spayed cavalier king charles spaniel who is presenting today for a stiffness of the hind legs. She is also come in today for a vaccine of kennel cough however will talk too about leptospira vaccine as well. HISTORY:SPECIFIC HISTORY: Stiffness only noticed about about a couple months ago (possibly 6) however it is intermittent comes and goes. Noticed that the hind legs a bit stiff to get up after sleeping however warms into it and doesn’t bother her as much. Isn't struggling on walks or chasing balls owner hasn't noticed any severe discomfort during these activities and noted never squealed or made painful noises.   NON-SPECIFIC HISTORY:   LIFESTYLE: Indoor most the time. Once a day big walk for owner and a smaller one in evenings. Goes to daughters  BEHAVIOUR ISSUES: At Vet/At Home: Quite comfortable and chill at home enjoys her activity, pretty good at the vets does get a little anxious.    OTHER PETS: only pet at the moment    DIET: Always had bladder problems, is on hills since urinary metabolic (2 cups a day) CURRENT OR RECENT MEDICATIONS: None   APPETITE,THIRST,COUGHING ETC: EDDU all normal and consistent. No coughing or sneezing, vomiting or diarrhoea. EDDU is normal but seems to be hungry a lot.    VACCINATION: Due for vax PARASITE PREVENTION (incl. Compliance): Nexguard spectra UTDPHYSICAL EXAMINATION: WEIGHT: 12.2kg FAS SCORE: 2/5 MENTATION: BAR HR:  120                                   PULSE QUALITY:  Femoral pulse strong  RR:  Panting                                             TEMPERATURE: Not taken          INTEGUMENT:  No lesions or parasites. Healthy coat and skin. CIRCULATORY: Normal heart auscultation. MM pink and moist, CRT <2sec, no heart murmurs or arrhythmias, femoral pulses strong and synchronous. RESPIRATORY: Normal auscultation. No wheezing or crackles, normal bronchovesicular sounds bilaterally DIGESTIVE: No palpable abnormalities on superficial or deep palpation of the abdomen. Comfortable on palpation. Oral Cavity:  There is some gingivitis and calculus build-up present. GENITOURINARY: No discharges from vulva. Desexed animal.  MUSCULOSKELETAL:   Generally stiff gait on both hind legs, with a 3/5 lameness noted at the walk on the RH. ###On palpation of RH stifle, there is a bony swelling on the medial aspect and crepitus felt on flexion.Cranial drawer test negative. Positive sit test on RH. ###Proprioception test normal, spinal palpation normal, positive sit test,    	 NEURAL: Normal, appropriate mentation, full neuro exam not performed. LYMPH NODES: Submandibular, prescapular, and popliteal lymph nodes symmetrical and normal size and consistency EYES: Both visual, corneas transparent, no blepharospasm or epiphora. EARS: Responds to auditory stimulus, ears free of discharge or odour. Some wax build-up though. BODY CONDITION SCORE:    	7/9   IN-HOUSE DIAGNOSTICS (with findings):Consulted surgical team to conduct a musculoskeletal exam: see above###Was found that there was crepitus in the right stifle also was found to possibly have a small tear in the cruciate ligament, finally there was indications of bony changes indicating possible arthritis ##CBC: WNLBiochem:Marked increase in ALP  Hypertriglyceridemia 807 (0-94)Hypercholesteremia Slight lipid in plasma Normal ALT ASSESSMENT, including your clinical impression of the animal: Problem list:1. Lameness 3/5 Right Hind limb, with bony swelling on the medial aspect and crepitus felt on flexion.Cranial drawer test negative. Positive sit test on RH. Likely an old meniscal injury and partial CCL tear with medial butressing of the stifle, chronic OA changes to this joint have now likely been exacerbated by old age and weight gain.2. Periodontal disease### 1. Crepitus in the right stifle near the patella region à thought to possibly be a meniscal issue 2. Possibly have a small tear in the cruciate ligament3. Bony changes present on right stifle which could be linked to osteoarthritis #####3. Possible Hyper A: Marked increased ALP, Hypertriglyceridemia, Hypercholesteremia--> most likely endocrine in origin - High suspicion of HyperA. ###Considering this with the normal ALT more likely to be bone disorders which links to what was suggested on surgical examination.###Hypertriglyceridemia --> Overweight body condition, could be endocrine diseases like Hyperadrenocorticism, hypothyroidism, diabetesHypercholesteremia --> Possible reasons: hypothyroidism, Hyperadrenocorticism (which also aligns with hypertriglyceridemia and altered lipid production (seen in plasma), diabetes mellitus, liver dysfunction, protein losing nephropathy (which is less likely as other kidney functions normal even thought has had previous bladder issues), pancreatitis and diet issues.Decreased creatinine --> likely insignificant - Could be possible ddx of liver disease, muscle wastage or damage )Slight lipid in plasma --> could be due to overweight condition of the dog, endocrine disorders like Hyperadrenocorticism, hypothyroidism, diabetes, pancreatitis. TREATMENT: For the stiffness of the hind limbs it was decided to start on a meloxicam trial (give and 11kg dose once daily PO. In order to this bloods were also taken to check the liver and kidney function to see how the meloxicam trial affects the kidneys and liver. This will be redone in a months time when Maggie is rescheduled to come in for a booster leptospira vaccine. Also to assist with the arthritis discussed with owner about weight loss which is needed lowering 2 cups of hills i/d urinary and metabolic kibble a day to maximum 1 and a half (more ideally 1) a day and supplement with some cooked vegetables like broccoli and carrot. PLAN (incl. alternative options): 1. Given leptospira and kennel cough vaccines 2. Took bloods to check kidney and liver function and whilst waiting for results started on a meloxicam trial (11kg dog dose SID PO)AT NEXT APPOINTMENT IN 2-4 WEEKS1. URINE SAMPLE - usg and dipstick2. FASTED BLOODS - vpds LIVER PROFILE3. BLOOD PRESSURE IN CONSULT4. LEPTO BOOSTER 5. RECHECK LAMENESS AND DISCUSS ACTH STIM +/- ABDO ULTRASOUND Reduce food given from 2 cups to ideally 1 cup per day with vegetables like broccoli and carrot (max 1 and a half cup) ASA Classification (if applicable): I   VACCINATION DETAILS:Vaccination injection site:  Type of vaccination given: Nobivac Lepto 2 Brand of vaccination: MSD Batch number: A003A01 Expiry date of vaccine: 10-2026Vaccination injection site: Intranasal Type of vaccination given: Protech Bronchoshield III Brand of vaccination: Boehringer Ingelheim Batch number: 5267026B Expiry date of vaccine: 23.04.2027    Vital Signs