C09999346 / invoice 10000

Appointment Notes: zydax Subjective: OR sore on HISTORYPresenting for: Ralph presented for assessment of left hind limb pain and arthritis management, glucose sensor check, and dietary consultation for diabetes management.Historical Conditions:- Diabetes mellitus on insulin therapy- Left hind limb arthritis - previously diagnosed- Spinal issues with bulging discs affecting nervesCurrent Meds:- Insulin- Fluoxetine- Clonidine slow release- Captopres- Gabapentin 100mg BID (increased to TID recently due to pain)- Meloxicam as needed (used last 4-5 days, causes reduced appetite)Diet:- Previously on mobility diet but went off it- Changed to Prime 100 beef (22/2/25) for diabetes management- Appetite reduced when given Meloxicam- Owner wants to vary flavours to prevent boredomOther:- Glucose sensor lifting off fur with 7 days remaining, previously replaced multiple times- Gets sore at farm visits with reduced mobility- Owner performs massage but leg remains sensitiveEXAMMusculoskeletal:Left hind limb: Significantly reduced range of motion (75% reduction), pain on palpation with vocalisation, hobbling gait, stiffness when rising, takes several minutes to walk normally after getting upASSESSMENTOsteoarthritis left hind limb - chronic condition with acute exacerbation causing significant pain and mobility impairment. Current pain management insufficient.PLANNew Meds/Tx:- Amantadine SID - works synergistically with Gabapentin for enhanced pain relief, can be used as needed but recommend daily dosing initiallyAdditional Discussion:- Meloxicam use acceptable on as-needed basis for severe pain days given normal recent kidney values, but avoid daily use- Cannot use Carprofen concurrently with Meloxicam (both NSAIDs)- Zydax injections could be increased from every 3 months to every 2 months- Librela injection (monthly) not recommended due to spinal/nerve issues- Arthritis information handout and Librela injection information provided for reviewDiet Recs:- Current Prime 100 beef diet appropriate (low carbohydrate, consistent protein)- Can vary flavours as long as nutritional consistency maintained- Fifty-fifty morning/evening flavour variation acceptableClient Comms:- Team will contact client over next few days regarding progress- Review arthritis management options from provided handoutsObjective: BARHR/PR/CV: HR ##, No murmur, pulses SSMM/CRT/Hydration: MMs PM, CRT <2s, #RESP/RR: Chest ausc. clear, no crackles / wheezing Temp: ##GIT/UG:  Abdominal palpation comfortable and unremarkableSkin/Ears: Well groomed, ears clear from discharge on exam of the external ear canal and pinna M/S: Ambulating well around consult Eyes: bright and clear, no ocular discharge Dental: Gr ##/4Lymph Nodes: PLNs WNL BCS: ##/9Assessment: Treatment: Zydax 0.4ml s/c Amantadine 50mg PO SID (Discussion with Owner: ) Plan: > mobility / chronic pain> OA/DJD > ongoing> none     Vital Signs