C09992380 / invoice 20000

Reason: Swollen Leg + Walking FunnyConsult Time: 11AM Hosp vet: AJUHistory:Jimmy is a 10y MN Doberman X who presents for acute onset lameness and tarsal swelling. OR on Monday possible trauma associated with Jimmy jumping in car. Uncertain whether this was truly associated or not. Since Monday Jimmy has had LPL lameness which was not present previously. O also notes Jimmy has what she believes to be acute swelling of the L tarsus. Has a hx of OA which he receives monthly injections for (presume Beransa). O has also given 500mg paracetamol PO the last few days which seems to help. Otherwise EDUD well. No V+ or D+ Previous medical history:Recent lumpectomy from caudal body (O not specific about location); histopathology returned benign (awaiting PCV hx) History of OA Current medications:Beransa SQ monthly Paracetamol 500mg PO PRN Diet: Black Hawk dry Appetite: Good Toileting: Normal Access to toxins: Nil Environment: No changes Preventatives: UTD Objective: T:  NP            MM: pink, moist P:  120 bpm       CRT: 1-2 sec R:  pant Demeanour: BAR Hydration: EuhdyratedWeight: 59kg Body Condition Score: 7/9Muscle Condition Score: 2/3 Cardiovascular: No murmur or arrhythmia, pulses strong and synchronous Respiratory: Normal RR/RE, normal BVS Abdomen:  Soft and comfortable, no palpable masses or other abnormalities Peripheral LNs: WNLOcular: NSF Ears: NSF Integument: No lesions or masses Oral exam:  No oral lesions Musculoskeletal:  Visible L tarsal swelling; firm on palpation. Difficult to discern margins / extent. Subtle effusion proximal aspect. Painful on palpation. Had JOD assess; repeatable LS hyperpathia as well. Neurological: Mentation appropriate, no ataxia, detailed examination deferred Rectal:  NP Laboratory: Owner declined today. Reportedly had blood work @ PCV 2-3 Mo ago (requested, pending) Assessment: Problem List:- Acute LPL lameness- L tarsal swelling DDx acute vs chronic - Historical OA Jimmy presents for acute onset LPL swelling and lameness. Pain and swelling are localized to the L tarsal joint, which is both grossly and palpably enlarged relative to the R. DDx include: severe OA vs septic arthritis vs CSA vs OSA vs trauma vs other. Advised only able to RIRO more severe conditions such as CSA/OSA with imaging, so recommended admission for XR. Offered CT scan as an alternative after speaking with JOD, and owners declined. Elected to proceed with XR imaging today to determine Dx and Tx plan moving forwards. Treatment: Nil Plan: Admitted and handed to JOD for re-assessment +/- XR +/- arthrocentesis if required TGH this afternoon/ evening. Client communication: Discussed DDx with O. Also discussed recommendations provided by JOD. Owner declined CT scan on the basis of cost, despite having pet insurance (O beleives they have to pay a 50% gap). Advised Jimmy will need to stay for the day. JOD will re-assess later on and call O with findings. Discussed for XR +/- joint tap if required, that Jimmy would require at least a sedation (possibly short GA). Owner aware and consenting. Offered blood work which owner declined. Will request hx and bloods from PCV.    Vital Signs    Weight: 59;       

Reason: Swollen Leg + Walking FunnyIntern: MM Subjective: Jimmy presents as a transfer from ARH emergency for L hock swelling and RPL lameness. Objective: T: NPMM: Pink    CRT: 1-2s HR: 120 bpm RR: Panting Demeanour: BARCardiovascular: No murmur auscultated, sinus rhythm, femoral pulses strong and synchronous, normal peripheral temperature Respiratory: Clear bronchovesicular sounds bilaterally, normal respiratory effort.Abdomen: Soft, comfortable on palpation. Oral exam: NSFEars: NSFEyes: NSFIntegument: NSFLymph nodes: NSFMusculoskeletal/Gait: Grade 4/10 RPL lameness, marked L hock swelling. Stifle palpation within normal limits, no effusion detected, and patellar tracking is normal. Mild-moderate lumbosacral pain on palpation.  Neurological: BAR, mentation appropriate, full neuro exam not performed. Rectal: Not performed Procedure: Stifle and hock radiographs performed of the PLs XXXXXXXXXXXXXXXAssessment: Suspect cruciate rupture RPL and concurrent stifle OA bilateral PLs and L tarsus. Treatment: Commence: - Meloxicam 59kg mark PO SID Plan:    Vital Signs