C09989588 / invoice 10000

Reason: Meds And Injections + Limping Appointment Notes: Overdue remindersHISTORY:  Luna presented for a recheck of her severe bilateral elbow arthritis and for medication refills. Ketamine injections have been stopped as per the plan to reserve them for end-stage pain management. She has been commenced on CBD oil (0.5ml twice daily), though the owner is unsure of its efficacy. The owner reports an increase in limping over the last few days, although she was walking well on presentation today. There was recent weight gain of approximately 1kg over a month, which may have contributed to the increased lameness. The owner has been administering Gabapentin 400mg twice daily but will now increase to three times daily. She is also dragging a toe, which was previously bleeding but has since healed. Appetite is good, but she is showing a preference for wet and dry food mixed, otherwise leaving the dry food. She has also been observed eating soil.Previous consult 29 days ago noted Luna was doing well on her medication regime, with a plan to cease ketamine injections and trial CBD oil. Bloods taken at that visit showed a mild elevation in ALKP, considered likely secondary to her severe osteoarthritis. Current meds: Gabapentin 400mg three times a day, Amantadine 100mg twice a day, Meloxicam once a day, CBD oil 0.5ml twice a day.Vaccination: Annual heartworm injection administered today.Parasite Prevention: Bravecto for fleas/ticks (owner obtains elsewhere). Intestinal worming tablet due 02/04/2026.Pre-existing conditions: Severe bilateral elbow arthritis with pronounced bone formation.Access to toxins eg. Rodenticide: none EXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, sinus arrhythmia heard, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: Both elbow joints feel warm, indicating inflammation. There is significant periarticular thickening and reduced range of motion, particularly in the right elbow. Gastrointestinal:- Oral: muzzled- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: Ears are clean with no signs of infection. Multiple small, soft subcutaneous masses are present, consistent in feel with lipomas. NSF (adjust if changes mentioned)Lymph Nodes: NSFEyes: NSFDemeanour/Behaviour: Bright, alert, and responsive. PROBLEM LIST:1.  Severe bilateral elbow osteoarthritis - chronic, progressive.2.  Lameness - intermittent, worse in recent days.3.  Pica - eating soil/sand.4.  Heartworm prevention overdue. DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Severe bilateral elbow osteoarthritis. DIAGNOSTICS:None ASSESSMENT:Luna presented for an arthritis recheck. Examination confirms signs of active inflammation in both elbows, with significant chronic arthritic changes. The owner's report of increased limping is consistent with these findings, potentially exacerbated by recent weight gain. The current pain management plan appears adequate for maintaining comfort at rest, but the increase in Gabapentin dosage is warranted. The pica may be behavioural or related to other underlying factors. Heartworm prevention was updated. TREATMENT:  - Proheart SR12 injection (heartworm prevention) administered subcutaneously.- Dispensed Gabapentin 400mg x 100 tablets.- Dispensed Amantadine 100mg x 100 tablets.- Provided 1ml syringes for CBD oil administration. PLAN:- Continue Gabapentin 400mg three times daily.- Continue Amantadine 100mg twice daily.- Continue Meloxicam once daily.- Continue CBD oil 0.5ml twice daily.- If pain is not controlled after two weeks, a Ketamine injection may be considered.- Intestinal worming tablet due in April.- Re-evaluation as needed.- Home into owner's care. CLIENT COMMUNICATION:Discussed examination findings, confirming the presence of inflammation in the elbows. Advised continuing the current medication plan with the increased Gabapentin frequency. Discussed that if her pain worsens significantly, a Kenalog injection is an option for short-term relief, but the goal is to reserve this for when absolutely necessary. Advised on the administration of Proheart injection for heartworm prevention. Provided medications and syringes as requested. Advised to monitor for any changes in mobility or comfort.    Vital Signs    Weight: 22.55;       Temperature: NT;       HeartRate: 100;       RespirationRate: 40;