C09996966 / invoice 20000

History: Presented this morning as seemed to have deteriorated further. Now not ambulating without significant support. Still eating but has not noted to defecate / urinate. Was given pregabalin and amoxyclav as instructed yesterday.Current medications: Amoxyclav 500mg 2 tab PO BID Pregabalin 150mg capsule 1.5 capsule PO BIDParacetamol 500mg tablets 1 tab PO BIDDiagnosis: Osteosarcoma left thoracic limb, amputation 28/10/25, chemotherapy commenced 4/11/25. Examination: Weight - 55.1kg Mentation - BAR RR - Panting, normal effort MM Pink, moist, 1-2sec CRT HR 90bpm, pulses strong & regular Temp - 38.1 Comfortable on abdominal palpation Doppler BP 156 mmHg #5 RFL Neurological> Mentation: BARGait: RFL paresis, unable to weight bear on all 3 limbs without significant support. Tone: Normal Spinal pain: no pain No head tiltNo intention tremorsCranial nerves Menace (S CN2 - optic; M CN7 - facial): Present bilaterally Palpebral (S CN5 Trigem; M CN7 - facial): Normal/present bilaterally PLR (S CN2 - optic; M CN3 - oculomotor): present direct and consensual bilaterally Vestibulo-ocular reflex (S CN 8 - vestibulocochlear; M CN3/4/5 - oculomotor, trocholear, abducent): No head tiltStimulation of nasal mucosa (S CN5 - trigeminal): Normal Jaw tone (S CN5 - trigeminal; M CN5 - trigeminal): Normal Facial symmetry (S CN2/5 - optic, trigeminal; M CN7 - facial): Normal Gag reflex (S CN9/10 glossopharyngeal, vagus; M CN9/10): Normal Tongue evaluation: Normal Nystamus- physiologic present, no positional. General proprioception Knuckling: present Postural reactions Hopping: not assessed Wheelbarrowing: not assessed Hemiwalking: not assessed Extensor postural thrust: not assessed Spinal nerves Patella (Femoral n - L4/5/6): Normal L and R Pelvic limb Withdrawal (L6/7 S1/2): Normal L and R Thoracic limb Withdrawal (C6/7/8, T1/2): Normal L.Sciatic (L6/7 S1/2): Normal L and R Cranial tibial (L6/7 S1): Normal L and R Perineal (S1/2/3, pudendal): Normal Deep pain present in all limbs Laboratory:CBC and biochem wnl. Assessment:Normal neurological findings. Bloodwork excludes systemic reasons for acute weakness. Suspect MSK involvement of RFL. Recommended OMAR assessment this afternoon prior to escalation to further diagnostic imaging modalities. Significant pain elicited on proximal-mid L humerus - mild-moderate periosteal reaction noted on proximal cranial and caudal humerus with radiolucency of proximal humeral medullary cavity. While this does not definitively mean tumor growth, a CT scan is recommended as next diagnostic steps should chemotherapy or more aggressive therapy (i.E radiation) is an option to be considered. Otherwise, palliative management or humane euthanasia is also not an unreasonable option.Plan:OMAR assessment this PM.Repeat imaging - start with CXR +/- XR of limbs and possible escalation to CT if required. Humane euthanasia in hospital opted. Owner communication:05/03/2026 10:40:32 KW updated Ashley on findings and plan as above.    Vital Signs    

Reason: OMAR Assessment - KW Spoke To AYKORTHOPEDIC EXAM:1. Gait/Posture: Tripod - missing left thoracic limb; intermittent collapse of the right thoracic limbs2. Thoracic limbs:- Right shoulders: normal ROM   ** moderate pain during long bone palpation of the right humerus (proximal/mid) - Right elbows: normal ROM; no effusion; no periarticular thickening - Carpi: unremarkable- Digits: unrmarkable3. Pelvic limbs:- Hips: no pain during ROM - Stifles: unremarkable- Tarsi: unremarkable- Digits: unremarkable4. Axial:- Spine: no cervical pain; no TL spinal pain - Epaxial muscles: unremarkableNEUROLOGIC EXAM: 1. Function/voluntary movement: unremarkable2. Mental status: normal3. Cranial nerve: normal4. Postural reaction - general proprioception: normalx45. Spinal reflex- Withdrawal: normalx4- Patellar reflex: normal- Perineal reflex: normal- Cutaneous trunci reflex: normal- Crossed extensor reflex: none6. Pain: - superficial pain: unremarkable- deep pain: presentRecommend humerus radiograph    Vital Signs