C09999288 / invoice 10000

Reason: Bulimba Vet Client - Osteo/age TreatmentHistory:Onset: OR after intestinal  FB and long stay in intensive care, O feels really aged. Really noticed deterioration in gait from mis '24, when started beransa injections. Diagnostics: cardaic and abd US at VSS, no joint rads. Previous treatments: meloxicam in the past. Beransa given SIM 09/24-05/25; after initial 4w O felt had seen dramatic improvement. Current medication: nilCurrent supplements: antinol Current Diet: lykaTriggers: ball play/excessive exercise (O has limited ball play)Current exercise: ~1- 1 1/4hrs, over 2-3 walks/dayPrev exercise: 2hrsSIDAreas/activities at home that are challenging: sometimes trouble rising/sitting. Slips on flooringhome flooring: timber flooringOther medical issues: - ? precursor DCM (lone AF), B1 MMVD (no meds, 12/12 cardiology review)- suspect BPH- hepatic mass ddx hepatoma vs carsinoma- bilateral adrenomegallyAims for therapy: Maintain quality of life and enjoyment of exercise and easediscomfort.Examination:   Stance: wide based to narrow  HL stance   Posture: stands with HLs forward under hips.    Gait: no appreciable lameness, although wide based mildly ataxic HL gait. In exercise yard had to stumble to catch himself a number of times. Struggled when standing on one leg to Ut. ? Neuro weakness vs oa.    Transitions: collapses in HLs when sitting. Prefers to lie. Reasonable engagement rising from a drop. S2s not a good option as not able to maintain. Reevaluate as builds strength.    spinal evaluation:cervical tense on PROM examination, but suspect doesn't like head held, as AROM following snack more comfortable in ventro and R latero flexion. Dorsi and L latero still a little tense; reevaluate next timethoracic mild hperpathia cau thorcics, reduced spinal bounce over region of kyphosislumbar " cr lumbars. ''  "  "SI NAD on palpation or tail lift.   Musculoskeletal:LF; mild tension in triceps, excellent joint ROMRF ; "LH; MFT through gracillus; suspect as has legs out behind a lot when walking, swing phase is reduced and 2ry tightening. Comfortable on coxofemoral examination, and reasonable extension. Reasonable symmetrical muscle mass.  RH; as above  Cr drawer/TT: negative    ortolani: NE   Neuro:CPP; HLs grossly delayed, R>Lwithdrawal normal menace normalfacial symmetry - NADCut trunci /anal-tail tone - NAD *OR has on occassion had faecal accidents inside at night if doesn't def while out walking. O not sure whether he's aware when this happens (not observed)sciatic/cr tibial/patella delayed. L>Rtriceps - NAD    Goniometry:stifle (40/162) L 45/156 R 45/158hip (50/162) L52/148, R 53/150Rest subjectively WNLs   Muscle Mass measurements (HL @ 70% femur length, FLs @ 20% antibrachium):HLs @ 15cm L 27.8, R 27.9 * tense on examination in side lying today. Measurements taken in standing. Stifles not fully extended as has a dropped HL stance with pelvis tilted forward, but feel accurate as both had similar stanceAssessment: Concerend re neurological component to decline; DM vs caudaequina vs other. Discussed referral to Christine Thompson to further elucidate. O prefer to Mx with us at this stage. Indicated would't consider advanced imaging or Sx, so Mx will most likely be the same regardless of cause. Def feel restarting beransa contraindicated Comfortable on MSK exam today, and excellent ROM - V mild spinal hyperpathia over kyphotic region of cau th/cr lumbar spine; suspect sig spondylosis- suspect combination of MSK and neurological disease. Treatment:Manual therapy;- stretching/PROM of gracilus bilaterally- manual MFT release of gracilus   Laser: back pain TL spine.    Stability: hasn't got good enough control for sit to stand. Manages drop to stand well. Weight shifting   UWT: red vest, HIT, on isolation plate but dropped back onto all 4s intermittently; trial without plate next time. Total of 7.5 min @ speed of   1.2km/hr over 3 session. Gracilus release during breaks. Gait patterning to increase swing phase. Plan:   At Home: Program : Program : HL strengthening for Furgal  Clare (Halina) as of 2026-03-04Lovely to meet you and Furgal today,Hopefully he'll forgive me for examining him!! He did really well for a nervous boy. Step stretch good as a warm up prior to walks or other activity - add in the forward and back movement to activate the gluteal musclesSome of these exercises can be incorporated together as we discussed; eg on the pool step with weight supported by the water, you can do the HL bicycling/PROM, with the gait patterning and proprioceptive toe drag all together.Sending twice as I realised I hadn't added the tricep work to the first one! Warm regards, Dr SimoneStep stretch (Sets:1 Repetitions:3 Frequency:once per day Duration:20-30seconds)Hot pack to Gracilis muscle (Duration:10 minute Other:prior to massage and stretching.)Gracilis stretch (Sets:1 Repetitions:15 Frequency:1x daily in conjunction with massage and heat Hold:15 seconds in extension Other:both legs.)hair trimming (Other:keep hair o bottom of feet trimmed nice and short all the time to minimise slips, and particularly doing the splits.)water walking on pool step swimming in the poolBicycling hind leg (Sets:1 Repetitions:10-15 Frequency:1x daily Tempo:slowly)Proprioceptive toe drag/withdrawal on textured surfaceGait Patterning (Other:focusing on slow movements and extending the swing phase (when leg is off the ground and moving forward).)Hip flexion and extension PROM (Sets:1 Repetitions:15)Lie down to standing (Sets:1 Repetitions:5 Frequency:daily)Weight shifting: back end (Duration:5 mins Other:when ever you think of it,)Triceps stretch (Sets:1 Repetitions:15 Frequency:2-3x weekly Hold:10-15 seconds at end of range. Only move the joints within a comfortable range Other:in conjunction with tricep massage)Triceps massage (Frequency:2-3x/week Duration:5-10 minutes Other:both forelimbs. can massage through the tricep muscle while out in extension if it's tolerated.)   In Clinic: 45  minute review c SF in 2w time after had a chance to try all exercises. Think hydro will be a very effective tool. O also going to negotiate with DH re letting him swim in the pool.Have recommended survey rads if under eg for dental/lump etc of hips and TL/SI spine. O not interested in a sept anaestheticRecommend trial on 500mg paracetamol BID for 3d as a therapeutic pain trialRecommend starting cartophen course (brochure taken); advised happy to give at rehab. Client Communication: HEP emailed.    Vital Signs