C09997600 / invoice 10000

PROCEDURE:

PRE-GA EXAM:
BAR
TPR WNL
abdo comfortable
_

PRE-GA BLOODS:

ANAESTHESIA:
Pre-med: methadone 0.2mg/kg and medetomidine 2mcg/kg
_ G  catheter placed _ cephalic
Induction: _ slow IV, to effect
Maintenance: Isoflurane, size _ ET tube, cuff inflated and tube secured
Anaesthesia and recovery uneventful

Peri-operative medication:
IVFT LRS @ _

SURGERY:
The surgical site was clipped and aseptically prepared.
An elliptial incsion was made around the mass. The mass was blunt dissected away from underlying tissue. The subcutaneous layer was closed with _. The skin was closed with _.

Post-operative medication:


POST-OPERATIVE INSTRUCTIONS:

_ has been a lovely patient while in hospital with us at Bundoora Vet Clinic.

_

Please keep them quiet and confined while they are recovering and have them wear the plastic collar provided to prevent them from licking at their wound. 

We are sending them home with medication, please give as directed on the label.

Please book them back to us for a recheck in 3-4 days and in 10-14 days for stitch removal.

It has been our pleasure to care for _. Please do not hesitate to contact us if you have any concerns, we wish them a speedy recovery.

HISTORY:
Presented for: NWB LHL
OR unable to weight bear on LHL since Wednesday 
No noted trauma but was running around in the garden at the beach house 
Last night didn't want to eat his dinner and he didn't want to get out of bed 
No noted wounds but has been chewing on the foot and managed to chew the nail off before he started limping 
O thinks the foot feels floppy 
No current medication 
Underlying health conditions: previous MPL at Greencross Warringal - performed on RHL, ischaemic dermatitis previously diagnosed
No breakfast this morning 

EXAM:
Mentation: QAR
Eyes: mild grey discharge from R eye 
Mouth: marked dental disease 
MM: pink, moist, <2
LNs: WNL 
CV: HR: 140, regular rhythm, no murmur 
Resp: regular rate, effort, pattern and all lung fields clear 
Abdo: soft and comfortable 
MSK: ambulatory x 3, NWB LHL, thickening of LHL medial stifle, no appreciable cranial drawer on conscious exam in LHL, grade 2/4 LHL MPL, no noted FB in toes, abnormal thickened nails on LHL but not growing in paw pad, allows flexion, extension and rotation of all joints comfortably but ongoing NWB
T: 39.1

ASSESSMENT:
LHL NWB lameness ddx: soft tissue injury vs fracture vs dislocation vs MPL flare up vs other 

PLAN:
Offered:
1. Admit for GA and radiographs 
2. Trial pain relief and INI then return for radiographs - adv if returning over weekend or on public holiday then cost will be higher for admission and may not be able to guarantee procedure done on the day due to increased emergency load over weekend 

O elected option 1 after discussion with insurance company 

MEDICATIONS:
- Methadone 0.2mg/kg IV q4 hours 

HOSPITAL PLAN:
Handed to sx team for GA + radiographs of HLs + hips
Evaluate for cranial drawer whilst under GA

DC home with:
- Loxicom 0.2mg/kg SC then 0.1mg/kg PO q24 hours 
- Gabapentin 100mg PO q8-12 hours 

COMMUNICATION:
As above

NB STO @ 4pm: adv of chronic OA changes in L stifle joint + 3/4 MPL suspect acute flare up. Discussed O seeking second opinion from specialist surgeon as given degree of disease in joint and degree of pain/chronicity of issue, will likely benefit from surgery. Adv in the mean time manage with pain relief and strict rest. 

HISTORY:
Normally not great with jumping 
In last week or 2 isnt trying to jump on couch, now hesitates with stairs
Walking around with tail between legs, shivering, doesn't want to walk around
Last weekend was still excited to go for a walk
normally excited in car but not excited today when getting in car
Yelped when picked up, 3 times yesterday, once today

Vacc on last monday (KC)
Luxating patella surgery in Jan 2024, O thinks R, was fine after 8 weeks after surgery

Half sister is fine, better mobility than Teddy
No V/D
Appetite good
water intake nothing for last 30 hours,otherwise normal last 2 weeks 
EDDU normal
Diet: raw diet, proudy (pet shop food beef, kangaroo, lamb), royal canin dry food, steak/lamb/chicken raw human grade meat

Diagnosed with iscaemic dermatitis previously via biopsy @whittlesea vet, presented there with no fur on muzzle mainly between eyes
Was told that iscaemic dermatitis can go on to effect joints and jaw. Currently cannot chew any food hence why dental dz is so bad
Going into a kennel on next wednesday

Presented for: painful recently, reluctant to jump on furniture or up stairs

EXAM:
Mentation: BAR
BCS: 5/9
Hydration status: hydrated
Eyes: periocular fur thin, 
Ears: NAD
Nose: watery discharge present, one drop present on nose
Mouth: gr 4/4 dental dz
MM: pink CRT<2s
Throat: NAD
LNs: WNLs
CV: HR: 140 BPM, no M or A
Resp: normal rate, effort, bv sounds
Abdo: tense, no vocalization on palpation but flinches when palpated, especially caudally
MSK: Left hindlimb luxating patella gr 2/4, no obvious pain on manipulation of forelimbs, hindlimbs, spine or neck
Integ: Mild periocular thinning of fur
Neuro: NAD
Genitourinary: NAD
Rectal: NAD, faeces present in colon
T: 39.3

Lab:
Mild ALT elevation 205 U/L (10 - 125) 
Otherwise CBC, biochem WNLs

ASSESSMENT:
Pain of unknown origin - ddx suspected spinal pain vs abdominal pain

PLAN:
Trial pain relief for spinal pain if no improvement then spinal rads
Meloxicam 0.1mg/kg PO for 5 days
Gabapentin 100mg BID-TID 
Fentanyl patch 25ug/hr applied @13/9 @11:30am
R/v if worsening or no improvement in 3-4 days

COMMUNICATION:
as above