C09997190 / invoice 10000

06/03/2026 History:
- Presented for right forelimb lameness and diarrhoea
- Right forelimb lameness started 2 days ago after running after a toy; has had intermittent limping episodes previously that resolve within 10-15 minutes, but this episode has persisted longer than usual
- Lameness worsened today after lunging at another dog while on lead
- Diarrhoea started today after receiving Drontal and Bravecto; has had previous episodes of GI upset following worming tablets
- Diarrhoea: light brown colour, no blood or mucus, resolved by afternoon
- No vomiting
- Appetite good
- Energy levels slightly reduced, lying down more than usual, possibly due to pain
- Currently on chicken and rice diet; started mixing in normal food 3-4 days ago
- Stopped Procolon probiotic paste a few days ago
- History of sensitive stomach

Physical Exam Findings:
- Temp: Normal
- Behaviour: Nervous during examination, muzzled
- Cardiovascular: Heart sounds normal
- Respiratory: Lungs normal
- Abdomen: Gut sounds normal
- Musculoskeletal: Right forelimb - pain on flexion of carpus/wrist area; no pain on palpation of elbow or shoulder; no swelling; no crepitus or clicking; nails intact; no wounds or foreign bodies in paw

Assessment:
- Problem list:
1. Right forelimb lameness - suspected soft tissue injury to carpus
2. Diarrhoea - likely secondary to Drontal administration or stress

Plan:
- Paracetamol - prefers tablets to the liquid (children's 120mg tablets, 3/4 tablet) twice daily for pain relief
- Rest for next few days, lead walks only for toilet breaks
- Continue Prokolin as needed for GI upset
- Continue chicken and rice diet; transition back to normal diet once stool normalises
- If lameness not improving, x-ray right carpus
- If diarrhoea persists, submit faecal sample for testing
- Consider alternative worming tablet (Milbemax or Milpro) if Drontal consistently causing GI upset

Communications:
- Discussed that Drontal may be causing GI upset; can try separating Bravecto and Drontal administration by a day to identify cause
- Discussed alternative worming tablet options if Drontal is confirmed to be the cause
- Discussed paracetamol dosing for pain relief as gentler on stomach than stronger anti-inflammatories given sensitive GI tract
- Discussed that Procolon can take 48+ hours to take effect due to fibre transit time