C09996599 / invoice 10000

History: no further pain episodes - had 2 episodes of crying when went to be picked up at time of prev consult. Otherwise wellExamine: tpr wnl. Normal gait, normal rom all 4 limbs. Spinal palp nsfPlan: rec x-raysSedation methadone/domitor. Alfax, maint cuffed et tube, iso 02Hartmanns @ sx ratesX-ray spine, HLSLateral lux patella bilateral, gr1 Stifles palpate stable under gaSpinal rads - full spine nad. No mineralised discs or obviously narrowed disc spaces. Hips nsfStifles nadLikely a soft tissue injury that has resolved    Vital Signs    

Reason: PAINSubjective:Owner reports Snoopy had a recent episode of pain when picked up but was otherwise active and walking fine. Snoopy is a Dachshund, a breed prone to spinal issues. Recently increased Fluoxetine dosage to 3/4 of a 20mg tablet daily due to behavioural issues.Objective:T , BW kg, BCS /9HR: , MM pink, moist, CRT < 2secEENT - No nasal discharge, no other significant findingsDENT - NADH/L - Normal rhythm, no murmurs. Pulses strong & synchronous. Normal RR & effort.ABDO - Soft, non-painful, no palpable massesUG - WNLMSK - NADNEURO - Gait & mentation normalOther issues - RH patella luxates laterally on palpationAssessment:Recent pain episode when picked up - Possible musculoskeletal or neurological issue related to breed predisposition to spinal problems.Plan:- Continue current Fluoxetine dosage, monitor for any food aversion.- Consider X-ray of the spine to check for calcified discs, especially if pain persists or worsens.- Recheck in a few days to assess if any new symptoms arise or if pain persists.- Prepare an estimate for potential X-ray and discuss with insurance for coverage.--- 02/03/2026 17:47:38 MRB: Pre approval form on gap only sent--- 03/03/2026 10:48:13 BIR:The expected gap amount to be paid by the client (based on the estimate submitted) is: $337.90    Vital Signs    Weight: 6.8;