C09994655 / invoice 10000

History:Worming/Heartworm/Flea control status:Nutrition:Examination:COAT/SKIN:EYES/EARS: MOUTH/TEETH:HEART: LUNGS: ABDOMEN/DIGESTIVE/URINARY: CNS/MUSCULOSKELETAL: PERIPHERAL LYMPH NODES: WEIGHT/DIET: Body Condition Score:REPRODUCTIVE: Assessment:Treatment:Protech C4 SQ + Bronchishield I OralAnnual Heartworm injection XX ml SC Heartworm injection givenXX ml SC Annual Bravecto Quantum givenReason: Sedation/GA and radiographsPLEASE ENSURE VETS HAVE FINISHED EDITING XRAYS BEFORE THEY ARE FINALISED ON THE XRAY COMPUTER (Delete this note when completed)PLEASE ENSURE S8, NSAID & MISC. FEE QUANTITIES ARE ADJUSTED TO CORRECT AMOUNTS BEFORE FINALISING (Delete this note when completed)Procedure: premed: ACP XXml; meth XXml @IV catheter placed, alfaxan induction XXml slow IV to effect, intubated size XXmm cuffed ETT, maintenance isoflurane.Routine GA no complicationsIVFs - hartmanns @ surgical rates (XXml/kg/hr) throughout procedure.Radiographs:Plan:    Vital Signs    

Reason: MC - C5, Bravecto And ProheartAppointment Notes: /ctHistory: Recheck after further physio visits ARH- improving myofascial tension and spasms in RPL and right paraspina muscles however OR Winnie still very anxious, reluctant to walk and now barking and biting strangers and other dogsConcern for increasing anxiety possibly exacerbated by painStill EDDU normalNo V or DMegaeosophagusCurrent meds: Sildenafil oral liquid- 10mg/ml--> give 0.8ml BIDPyridostigmine (Mestonin) 10mg tablets--> give 3/4 of a tablet BIDThickened waterGabapenitn 100mg po BIDMeloxicam 5kg po SIDExamination: Limited as highly reactive to me in consultAssessment: Ongoing muscle painCannot definitively r/o IVDD- neurologically normalIncreasing agitation and anxietyBloods: mild haemoconcentration, all else WNLPlan:Plan for rads next week- lumbar spine, hips and stiflesDispense CBD oil script today- has been sent to Pet Cann- will deal directly with owner from hereStarting with 0.8ml once a day for 3 days then increasing to 0.8 ml twice a day for 2 months. Adjustments after 2 months if no effect. Cost - 188 dollars - pharmacy will contact the O In short term o to trial 200mg gabapentin PO SID in AMOnce bloods and rads done can consider referral to sx specialist for advanced imaging if nothing found and symptoms persist    Vital Signs    Weight: 9.9;       

Reason: Lethargic / PainAppointment Notes: Paws App Details:Booking Type: Consultation RevisitBooking Vet: Dr Matt CrossleyBooking Notes: Winnie is appearing lethargic and in pain today we have been to arch and have another appointment next week Owner Would you like to opt for an earlier appointment if one becomes available?: YesHistory: Still having some small back discomfort, especially over hipsEDDU normal but appears sad and less activeNot jumping at the momentCan walk normallyExamination: WNL- subjectively tender over hips but unreliable pain response due to demeanour Assessment: MSK painPlan:Rest, NSAID and gabaPlanned visit to ARH physiotherapy    Vital Signs