C09998332 / invoice 10000

NOTES: Reason:
- Presented for right forelimb lameness requiring radiographs; radiographs show radial shortening and poor congruency of the humeroradial joint consistent with antebrachial incongruence.

Objective: Pre GA Check
- Assess readiness for general anaesthesia for planned distal ulnar ostectomy. No pre-existing conditions documented.

LABORATORY
- Preoperative imaging: Radiographs of left and right forelimbs (mediolateral and craniocaudal). Right forelimb: radial shortening with poor humeroradial congruency.

TREATMENT
- Premed: Acepromazine 0.05 (units not specified); Methadone 0.2 (units not specified).
- Induction: Propofol used for induction (dose not documented).
Surgery Details:
- Surgery Started/Finished: Not performed today; distal ulnar ostectomy booked for next week.
- Technique: Planned distal ulnar ostectomy to address antebrachial incongruence (technique details to be performed at surgery).
- Anaesthetic Finished: Not mentioned.
- Recovery: Not applicable for today; patient sedated for radiographs/induction only.
- Pain relief: No postoperative analgesia documented today.

Plan:
- Proceed with booked distal ulnar ostectomy next week. Owner informed that surgery may not correct limb conformation but may improve lameness. Arrange preoperative assessment on day of surgery; ensure perioperative analgesia and anaesthetic plan at that time. Postoperative follow-up and recheck to be scheduled after surgery.

HISTORY: REASON – has had limp for 2 weeks after desexing

HISTORY - 
OR P has had limp since after Sx - inconsistent - OR think is right front leg
OR P has jumped a couple times and yelped when landing on it, when P has paw touched + it seems to hurt , also seems stiffer in am. O shaved paw pad and couldnt find anything in it, did seem reactive on pad manipulation. 

Appetite: WNL
Water intake: WNL
Urination: normal, no changes
Faeces:  normal, no changes 
Energy levels: good- difficult to keep patient still
Coughing or sneezing: no
Vomiting: no
Parasite Control: UTD
Vaccination status:  UTD
Current Medications: none 

EXAMINATION
Demeanour: BAR - very lovely boy, can be a wriggle worm
BCS: 5/9 
Integument: castration site looks good 
Eyes: bright and clear
Ears: clear
Nose: clean
Mouth:-
CRT:          <1 sec
MM: pink and moist
Dental disease: Grade - 0/4- all permanent 
HR: 122  BPM,    Rhythm: no murmur appreciated 
RR: 40  BPM,    Effort: none
Temp:   not taken 
Peripheral LN's: WNL 
Abdomen: comfortable on palp
Musculoskeletal: muscle atrophy over R scapula, reactive on palpation of R elbow (at olecranon process), ROM good. No reaction on palpation of paw and no abnormalities noted. Good ROM of R FL and doesnt seem to be reactive on movement. NO limping in consult. 
Neurological: NAD
Urogenital: NAD
Rectal: not assessed

ASSESSMENT: ST injury vs anatomical defect (elbow dysplasia vs HIF vs other) vs fracture vs other 

CLIENT COMMUNICATION:
discussed tissue vs joint pain- recommended radiographs of FLs vs a pain relief trial. Given patient so young and worried about anything effecting growth plates etc - rads better option, O keen to get done. Advised that if elbow problem etc. may need additional imaging to diagnose (CT). 
advised to try keep P rested as much as possible at moment


TREATMENT: 9kg dose meloxicam (1.5mg/ml) PO SID x 7-10 days 

PLAN:
O to give 25mg trazodone PO BID ongoing for next few days to try and keep patient quiet with reduced movement (O already has at home from castration surgery) 
Book in for radiographs of bilateral FL's - esp R elbow but as difficult to localise pain also do shoulder and wrist/paw. 
Possibly transfer to ASC consults if anything found anatomically on rads that requires more specialist care. 

ESTIMATES: $700-$1000 for fluorescein radiographs (including additional plates) - does not include specialist interpretation if necessary (advised about $200-$300 additional) 

REVISIT: booked for rads on
WEIGHT: 9.00

HISTORY: Remy presented for post op castrate check. very BAR.
CUTE friendly boy :)

FO advised very good recovery - wore e-collar for 8 days- 
Was dispensed trazadone - gave one day 50mg day after procedure - too much sedative effect
gave 1/2 tablet 50mg - on second 
EDUF all completely normal
Successfully administered post op anti-inflammatory medication. no reaction to NSAID

Incision site - looked AMAZING! fully healed over - no redness or inflammation at all 

FO only raised one concern that dog has been pulling up intermittently lame on front forelimb since procedure.
was running around in consult room happy during post op check. towards end of consult did see Remy favour front forelimb with elbow extended outwards. 
Recommended to continue to monitor - considering age - book in lameness work up and radiographs with Dr Steve / orthopaedic team for potential elbow dysplasia and / or other. 

Nurse: Jess G.