C09997965 / invoice 10000

Appointment Notes: C5 and heartworm , check leg struggling to get up thinks arthritis after he's rested,  not in pain and can get up and down sofa .**HISTORYAny health concerns (Limping RHL.  Mum is manipulating and massaging and this helps after periods of rest.Warms out if this.No known injury.  Cannot localise pain.)Any behaviour concerns (No)Current diet (Unchanged )Appetite and thirst (Normal)Vomiting or diarrhoea (None) Current medications (Beransa + heart medications (vetmedin 2.5mg BID). ) Worming, flea and tick prevention (C5 and SR12 due today.  Worming, F/T UTD ) **TRIAGE/TPRMM: (pink, moist, CRT <2 seconds)HR: (104 - grade III-IV  heart murmur  (not as audible today))RR: (Panting though lungs clear. )Temp: (38.8 )Demeanor (BAR, friendly and easy to examine - nervous)***FULL PHYSICAL EXAMEyes (Visual, normal eyelids, no abnormal inflammation or discharge - Nuclear sclerosis bilaterally + early cataracts)Ears (Minimal debris, no abnormal inflammation, odours)Lymph Nodes (peripheral nodes palpate normally)Oral (no oral lesions or abnormalities detected)Teeth (normal occlusion, grade (C2G1 ), moderate tartar, mild gingivitis.)COHAT Level Estimated: (A, B)Cardiovascular (Dx wtih MMVD stage 2-3. Grade III-IV/VI heart murmur present.  No notable arrhythmias detected, femoral pulses synchronous and normodynamic - Under the care of cardiology)Respiratory:Nose: (No abnormal lesions or discharge)Lungs: (Lung sounds clear bilaterally, no stertor or stridor detected, no cough observed)Abdomen (Soft and comfortable on palpation, no focal pain, mass effect or organomegaly detected, bladder unremarkable on palpation)Rectal (N/A)Locomotor(Ambulates normally)No lameness or gait abnormality observedFLs - Good ROM in all joints, no pain on palpation,HLs - RHL ROM decreased (approx 60%) - large 'clunk' on extension.  Not repeatable.  Discomfort noted on extension though - this was repeatable.  Muscle wastage in RHL.  LHL - 85% ROM with minimal discomfort.Spine - Flinching with palpation over T/L junction)Skin (coat is soft and clean, no ectoparasites detected - Lump caudal trunk - aspirated.  Sebaceous cyst only)Neurological (Normal mentation, no ataxia or CP deficits observed, CN exam normal)Reproductive (External genitalia appears normal, desexed)**ASSESSMENT/DDX(Nuclear sclerosis +/- cataractsGrade 2 dental diseaseHeart murmur G III-IV/VI - MMVD stage 2-3DJD spine?DJD hips, esp R hip.  Instability?)**CLIENT COMMUNICATION(Advised ideally we would like to Xrays though to get good view of hips, needs heavier sedation or GA.  Owner very reluctant to do this due to cardiac disease, esp if not going to change treatment.Recommended changing from Beransa to Metacam though will need to monitor bloods, esp liver as previous ALP elevations noted.Recommended consultation and treatment/management plan with Janet at Canine rehab.  Mum very keen for this and given brochure - will call and make appointment. )**MEDICATION/VACCINATIONS/SR12(Dispensed: - Metacam oral liquid - give 10kg dose (0.65mls) PO OID with FOOD. )**PLAN(Owner to book appointment with Janet at Canine Rehab. ) Verified: YESHISTORYPresenting for: Boston presented for intermittent hindlimb lameness and mobility issuesHistorical Conditions: Heart condition notedCurrent Meds: Tramadol 2.5kg BIDOther: Episodes of hindlimb locking or skipping out followed by normal walking, owner can manipulate leg to restore movement, patient shows no pain awareness during episodes, more noticeable on unstable surfaces and when first getting up, fine on grass surfacesEXAMMentation: BARWt: 12.5kgHR: 104 bpmBehavioural: Panting, tolerates examination wellCardiovascular: Grade III-IV/VI heart murmurMusculoskeletal: Intermittent hindlimb clunking noted during manipulation, patella normal, stifle range of motion adequate, spine palpates wellIntegumentary: Sebaceous cyst present - benign, no concernsASSESSMENTSuspected DJD/hip dysplasia with joint laxity - likely causing intermittent lameness and locking episodes, particularly on unstable surfaces. Patella and stifle appear normal.Sebaceous cyst - benign finding, no treatment requiredPLANNew Meds/Tx:- Metacam 10mL oral liquid at reduced dose for 10kg patient, monitor for vomiting or diarrhoeaChanges to Existing Meds/Tx:- Discontinue BeransaAdditional Discussion:- Referral to Janet at Coomera for physiotherapy, laser therapy, underwater treadmill, manipulation and massage- Home exercise program to be provided by physiotherapist- Recommend carpet runners through house for better traction- Recheck bloods in 3 months to monitor Metacam therapy- Avoiding anaesthesia and radiographs at this time due to heart conditionClient Comms:- Physiotherapy referral arranged - client to call Janet directly. Janet has full database access available- Monitor for any adverse effects from new anti-inflammatory medication- Carrots recommended as cost-effective dental chews    Vital Signs    Weight: 12.5;