C09999045 / invoice 10000

Reason: Rapid Breathing, Non Weight Baring, Nose DrippingHistory:- Medicine patient investigated on Friday for paroxysmal tachypnoea - no clear cause found, minor diaphragmatic hernia noted but thought to be incidental. - Acute onset left hindlimb lameness this morning, non-weight bearing - Walked fine at 9pm last night, no issues overnight - Similar episode in December - resolved with rest and anti-inflammatories, recurred after stopping - Unrelated incident: escaped during fireworks, ran several kilometers, tore pads, was started antibiotics then and hasn't been lame since, owners feel the antibiotics resolved the lameness.- Known to have arthritis previously noted on xrays at RV. - Recent cat scratch to gum noted - Some behavioural changes noted - increased aggression with other animals- last night SRR (viewed on video) was 80.Physical Exam Findings: - BCS: 12.5 kg - Mentation: Bright, alert - Intermittent left hind limb lameness noted here, was non-weightbearing at home, now masking lameness since arriving at clinic.Thorough MSK exam, good ROM all joints, although dog very tense when manipulating right stifle.No pain on forced extension of either stifle, hock, hip.Stifles have slight click but no effusion.Between paws all ok- no signs of infection.No pain on tail jack, sacral or lumbar palpation.Eyes: - NADEars: - NADRESP- Lungs clear bilaterally,  - SpO2 99% - Tachypnoea at rest, normalises when awake and active, not observed in consult, O reports only really happens when deep asleep.Assessment: - Problem list: 1. Acute left hindlimb lameness - aetiology unclear, no infection identified - however existing arthritis may be the cause. 2. Paroxysmal tachypnoea - ongoing investigation, no respiratory cause identified. 3. Congenital peritoneal-pericardial diaphragmatic hernia - incidental, no current treatment advised 4. Mild hip arthritis - previously identifiedPlan: - Meloxicam once daily with food for 3-5 days - Monitor lameness - if resolves with anti-inflammatories then recurs after stopping, repeat X-rays indicated - Continue monitoring respiratory rate at home - Record episodes and email to Susan (internal medicine) - If persistent concerns, consider CT thorax/abdomen/other - further bloods etc. - If arthritis confirmed as cause, consider long-term management and supplements (already on cartrophen and oral supplements)Communications: - Discussed that no infection identified on paw - O was hoping anitbiotics would fix the lameness like last time. - Discussed that current respiratory signs not causing hypoxia - oxygenation normal, heart and lungs sound normal - Discussed that diaphragmatic hernia unlikely related to current clinical signs given minimal herniation. - Discussed potential causes of tachypnoea including respiratory disease, reflux, tracheal collapse, chronic bronchitis, pulmonary hypertension, hormonal diseases (pheochromocytoma, Cushing's), brain disease, partial seizures, pain, stress - Discussed that if lameness resolves with anti-inflammatories then recurs, may need repeat X-rays to assess for arthritis progression - Owner to email breathing video to Susan for review - Owner aware diagnosis remains open, will continue monitoring    Vital Signs