C09995563 / invoice 10000

Reason: Coming Straight DownAppointment Notes: stiff in the hind end, lethargic, not eating, hiding in dark spaces. RHH Approved, CE aware also - ajsVerified: NoHistory:Presenting for: Nala presented for acute onset lethargy and reluctance to move, with the dog lying in one spot and going downhill over the past day.Historical Conditions:- Previous bilateral cruciate ligament surgeries- Arthritis in hind legsDiet:- Science Diet digestion formulaCurrent Meds:- Paracetamol given this morning- Arthritis supplements (non-specified)Lifestyle Risk Factors:- Outside dogs with known snake presence in area over past couple of yearsOther:- Dog took herself to dark spot behind shed and remained motionless for approximately one hour- Normally excited when visitors arrive but showed no interest when window cleaner came- Trembling observed- Catheter given initially thinking it was leg-related issueExamination:Mentation: BARWt: 36.5 kgT: 39.1°C (slightly elevated)Behavioural: Panting (not normal for patient), reluctant to move, seeking dark quiet spacesIntegumentary: Two hard lumps noted on one side with some puffiness, possibly from biteMusculoskeletal: Significant pain in lumbar spine area with sensitivity to palpation, hind leg stiffness, existing arthritis changes, delayed proprioceptive responses in hind feet, reluctance to bear weight on hind legsAbdominal: Pain response noted on abdominal palpationAssessment:Lumbar spinal pain - likely musculoskeletal injury or acute exacerbation of existing degenerative joint disease. Snake bite considered but presentation not typical for envenomation given patient's alertness, ability to walk, and normal mucous membrane colour.Plan:Diagnostics:- Blood clotting times discussed as option to rule out snake envenomation but not immediately recommended given atypical presentationNew Meds/Tx:- Meloxicam (NSAID anti-inflammatory) short course for pain and inflammation- Gabapentin for nerve pain with expected mild sedation effect to encourage rest- Paracetamol to continue as third pain pathway medication- Three different medications targeting different pain pathwaysAdditional Discussion:- Snake bite considered unlikely based on presentation - would expect ascending paralysis, loss of reflexes, pale MM, vomiting and diarrhoea- Pain response typical presentation for spinal injury given multiple nerve pathways from spine- Rest recommended for recovery- If long-term NSAID therapy needed, kidney function testing required before continuing- Panting attributed to pain response- Mild temperature elevation attributed to stressClient Comms:- Medications can be given immediately at home except paracetamol which was already given this morning- Gabapentin will cause sleepiness which is beneficial for rest- Patient should be more settled by afternoon- If improvement noted and long-term pain management needed, kidney function testing recommended before continuing meloxicam long-term    Vital Signs    

Reason: Coming Straight DownAppointment Notes: stiff in the hind end, lethargic, not eating, hiding in dark spaces. RHH Approved, CE aware also - ajsHx requested from mclaren vale, Client has given consent for Hx to be requested    Vital Signs