C09989993 / invoice 10000

Appointment Notes: VETSTORIA - Nile (Dog) - Sarah Oakleigh - 0478118753 - Consultation [Clinician : Dr Caitlin Dore(No Preference)] - Pain managment  - Web BookingClient name: Sarah OakleighContact number: 0478118753Email address: s_oakleigh@hotmail.comPatient name: NileSUBJECTIVE / HISTORY:Chronic Background (Summary):Nile has multiple significant chronic comorbidities including osteoarthritis with progressive mobility decline, hyperadrenocorticism (managed with trilostane), chronic sialadenitis/sialadenosis with progressive submandibular gland enlargement causing dysphagia and respiratory compromise, and recurrent pain episodes requiring escalating analgesia.He is currently on pregabalin 150 mg PO BID, monthly Beransa injections, meloxicam SID, amoxyclav SID, trilostane, and paracetamol. All medications were last administered at 7 am prior to presentation. In February 2026, meloxicam and amoxyclav were added for worsening sialadenitis and pain. Recent deterioration has included difficulty rising, difficulty negotiating ramps, worsening hindlimb weakness and lumbar pain, and increased salivary gland swelling with thickened secretions that are no longer amenable to drainage. Referral has been previously declined and management has been palliative in nature.CURRENT EMERGENCY PRESENTATION: Owner reports Nile tripped and his hindlimb became stuck in a gutter yesterday. Immediately afterward he was flailing and very difficult to assist. He attempted to bite the owner when being helped up. After returning home he remained unsettled and appeared painful. Owner noted discomfort in the right forelimb, with yelping on palpation and they presented to QVS PetER for assessment but opted to take home overnight. They reported he was given a 6 hr pain relief and slept all night however as soon as he woke up this am he was dragging RFL again. Only offering small amounts offered food. No V/D. Not himself. PHYSICAL EXAM:Mentation: Quiet, alert and responsive but not himself not trying to biteCVS: Normal cardiac rate and rhythm, normokinetic pulses, warm peripheriesRESP: Panting with mild respiratory effort and moderate stridor; clear   bronchovesicular lung sounds, no crackles or wheezesABDO: Soft and pliable, pendulous with thin skin, no pain; no focal abdominal painMSK: Able to right, rise no ambulation seen. No obvious crepitus or instability palpated. Possible increased instability of RHS glenohumeral joint vs mm laxity. EENT: Moist mucous membranes, mild ptyalism, strong gag reflex, eyes clearNEURO: Mentation dull, menace and palpebral reflexes WNL OU, conscious proprioception WNL; full neurological exam not performedLNs: Prescapular and popliteal lymph nodes WNLINTEG: Multiple superficial abrasions over dorsal sacral region. Torn nail LHL digit IIISignificant soft tissue swelling ventral cervical region (consistent with chronic salivary gland disease)UROGEN: NADRECTAL: Not performedPROBLEM LIST:1. Right forelimb lameness (acute traumatic episode)2. Chronic hindlimb weakness and muscle wasting3. Severe chronic osteoarthritis4. Progressive sialadenitis/sialadenosis with respiratory compromise5. Chronic pain with declining mobility6. Palliative care statusDIFFERENTIAL DIAGNOSES (Acute Lameness): Osteosarcoma, Soft tissue injury, Ligament rupture, Carpal subluxation/hyperextension injury, fractureTREATMENT : - 1 mg Methadone 0.05 mg/kg IM 0920 am- 20 gm Ketamine SQ 0920 am- 50 mcg Fentanyl patch <1.6 mcg/kg placed and ACTIVE 9 pm tonight LHS HL- Paracetamol dose TIDCOMMUNICATION:Detailed discussion held regarding: Likely causes of acute lamenessRisks associated with sedation/anaesthesia and imagingLimited treatment options given comorbiditiesQuality of life concernsDiscussed additional analgesic options; however, significant concerns remain regarding mobility, respiratory compromise, and overall comfort.Owner elected outpatient management at this stage and will discuss further options with family, including the possibility of humane euthanasia.Advised recheck in 2–3 day for patch replacement and to return immediately if deterioration occurs.Likely going home for a few days with family and will not continue tx    Vital Signs    Weight: 30.6;       MMColour: Pink;       RespirationRate: 18;       HeartRate: 80;       Demeanour: NR;       Hydration: Normal;       BodyScore: 5;       PainScore: 2;       CRT: 1-2;