C09991327 / invoice 10000

Appointment Reason: Ultrasound, Appointment Notes: #10.30am abdo u/s under sedation - GAP ONLY - dhPrimary Diagnosis/ Suspected Diagnosis/ Location: chronically off food, weight loss, elevated liver enzymes - liver and splenic neoplasiaSuspect cause: cancerAny other conditions being treated (if any): djd/arthritisKnown health concerns: djd/arthritisDate of first clinical signs (if known): 23/2/36 - weight loss since 4 months    Vital Signs    Weight: 5.52;       

reported TAHP - ok to have meloxicam rec abdo US with Dr Max to investigate elevated liver enzymes - O keen. nurse to email est.     Vital Signs    

HISTORYPrimary reason consult: chronic off food, shaky in hind legs, joint issuesConcerns: Tremors, weakness, reluctance to move, sitting to one side, weight loss. Getting slightly worse over time. Historical conditions: DJD/OAVacc due: next monthWorming/ flea/tick: UTDCurrent medications: one dose of meloxicam yesterday, owner ran ouMentation at home: quiet, alert, responsive. EDDU: Reduced appetite, not eating well, on and off. drinking/urinating normally. Skin: no pruritis, no lesionsLumps: few small cysts/skintags, no concernsMobility: Tremors, weakness, reluctance to move after sitting, hesitant going down, sits to one side, favors right sideRisk Factors: PHYSICAL EXAMCondition: Lost 400g over 4 months, muscle wastage around lower spine and hip areaMentation: BARMobility: Hind limb tremors visible, muscle weakness, reluctant hip movement, left hip better than right, sits leaning to side, weight bearing well on all 4HR/PR: clear on auscultation bilaterally, regular and strong pulseLungs/RR: lungs clear on auscultation bilaterally, normal breathing sounds and effortTemp: 38.7 deg CMM: pink, moist, CRT<2secTeeth: appropriate bite, clean, no gingivitisEyes: Mild cataract age appropriate, normal pupillary responsesEars: normal appearance of pinna and external ear canal, no malodourSkin/Coat: healthy skin and coat without redness, lesions, excessive hair loss or lumpsLnn: no enlargement palpable externallyAbdom palp: soft and comfortable, no masses or organomegally notedOther problems found: - Mild joint swelling stifles and stiffness noted- Muscle wastage around lower spine/hip area- Reluctance to hip extension on examination, mainly on rightPROBLEM LIST- Osteoarthritis with progressive joint disease- Weight loss (400g over 4 months)- Muscle wastage- Tremors and weakness- Reduced appetite- Mild cataractDIFFERENTIALS Ongoing osteoarthritis, rule out other causes of inappetence and weight lossTESTSIDEXX TAHP - awaiting resultsPLAN- Pain management with Meloxicam injection today- Baseline blood screening before starting long term anti-inflammatory medication- Joint supplement (4Cyte) to start immediately- Consider Synovan injections for winter- Weight management and controlled exercise program- Physiotherapy exercises at homeCLIENT COMMUNICATION- Explained osteoarthritis management plan- Advised regular exercise on even ground, smaller more frequent walks- Continue using ramps at home- Can do bicycle movements with legs for physiotherapy- Acupuncture and physiotherapy options available- Can collect Meloxicam once blood results reviewedTREATMENT- Meloxicam injection (24 hour coverage)    Vital Signs    Weight: 5.4;