C09994082 / invoice 10000

Recheck post-bilateral patellar luxation surgery. C/O occasional skipping gait on the RHL.History:• 1.5-year-old female dog.• History of bilateral patellar luxation surgery. The first surgery had a prolonged recovery due to pain from the surgical pins, which were subsequently removed. Recovery from the second surgery was uneventful.• Post-operatively, the skipping gait has significantly improved but persists occasionally on the RHL, especially during walks at full extension.• Has a history of a "lazy sit".• No reduction in exercise tolerance or enthusiasm for walks.• History of V+ post-operatively, suspected secondary to medication (possibly NSAID). The medication was changed.• History of needing anal glands expressed.• Minor history of ear issues, treated with topical medication.Vaccination:• UTD.Diet:• No recent dietary changes.Preventatives:• UTD.Medication:• Nil current.Examination:• General BAR.• BCS 5/9.• Eyes Tearing noted, suggestive of reduced nasolacrimal drainage.• Ears NAD.• MM Pink and moist.• Hydration NAD.• Dentition NAD.• Cardio HR 120, SR, no murmur.• Resp NAD.• Abdo Soft, non-painful. Anal glands expressed.• Urogenital NAD.• MSK Mild medial patellar luxation (MPL) noted on RHL, which is easily reduced. The patella moves smoothly when it luxates, suggesting a shallow trochlear groove. LHL stable.• Neuro NAD.• Skin NAD.• LN NAD.• Temp 38.1°C.Assessment:• Persistent mild medial patellar luxation of the RHL post-surgical correction. This is a known statistical risk (5-10%) of the procedure.• The ongoing luxation is likely due to a biomechanical issue, possibly an insufficiently deepened trochlear groove or persistent mild angular limb deformity, resulting in a non-linear pull of the quadriceps mechanism.• Condition is currently mild and not causing significant pain or disability but may worsen over time.Client communication:Explained that a degree of post-operative patellar instability occurs in 5-10% of cases. The cause is often multifactorial, relating to the patient's underlying limb conformation. Discussed that with modern imaging like CT scans, a more holistic view of limb anatomy is possible, allowing for more precise surgical correction than traditional methods. While a CT scan could precisely identify the anatomical cause for Timbit, it may not be necessary at this stage.Discussed management options. Revision surgery was presented as the definitive solution to correct the biomechanical problem, which would likely involve deepening the trochlear groove and repeating the tibial tuberosity transposition. The risks of further surgery were noted. A conservative approach with physiotherapy was also discussed as an initial step. I advised that while physiotherapy is less likely to resolve a biomechanical issue, it is a sensible first step to strengthen the quadriceps and supporting structures before considering another surgery. A 3-6 month trial of physiotherapy was recommended. If there is no improvement within this timeframe, it is unlikely to be effective.The owner and I agreed on a plan to pursue physiotherapy first. I provided contact details for animal physiotherapists with expertise in sports medicine. We also discussed that if we proceed to surgery, obtaining the surgical report from the previous procedure would be essential.Treatment:• Anal glands expressed.• Blood sample collected via jugular venipuncture for biochemistry panel.Plan:• Commence physiotherapy for 3-6 months to strengthen the RHL musculature.• Reassess gait and stability after the physiotherapy trial period.• If no improvement, consider referral for surgical opinion, which may involve a CT scan and revision patellar luxation surgery.• Await results of bloodwork.    Vital Signs    Weight: 5.03;