C09999981 / invoice 10000

Reason: Recheck mobilityReported pain meds orally made a differentCrepitus at stifle jointsRH luxates more easily than LCheck if SF/Libby are happy to do given chronicity and degree of OKVerified: NoReason: REX following OA injections and radiographsHistory:Radiographs performed last month revealed OA in both stifles, L worse than R, likely related to long term instability from bilateral patellar luxationCompleted course of 4 OA injectionsCurrently on OsteoCarePreviously dispensed anti-inflammatory tablets in January with good responseHx of difficulty rising noted in OctoberO reports episodes of holding up leg after sitting for 20-30 seconds before extending leg and walking normallyO reports improvement with injections but stiffness still presentLives on half acre property with cat, gets own exerciseNormal activity includes running and playing5 years oldExamination:BCS: Appropriate for pug cross cavalier body typeMSK: Bilateral patellar luxation present, both stifles with very significant OA, L worse than R, crepitus palpable both stiflesAssessment:Bilateral patellar luxationSevere bilateral stifle osteoarthritis secondary to chronic patellar instabilityIntermittent lameness related to patellar luxationPlan:Nails clippedContinue OA injections as neededContinue OsteoCareDispense anti-inflammatory medication for ongoing managementConversation with owner:Discussed limitations of surgery - can repair luxating patellas but cannot reverse existing OAO interested in surgical consultation given patient age (5 years) and QOL concernsWill discuss surgical options with Steve (orthopaedic surgeon)Advised anti-inflammatory medication will likely be long term managementExplained episodes of lameness likely due to patella luxating out of groove when sitting with bent stiflesO has pet insurance, will provide details for gap only claims    Vital Signs    Weight: 8;       

Reason: Sedate Rads Hip And StiflesHistory:  ZK admitThinks pain relief mad an improvementHealthy & otherwise, no V+ no D+ Has 3 days of meds left at home approxThinks UTD worming, vaccinations etcNO breakfast YES bloods Call brett, he'll pick up approx 3:30pm but confirm later, should be free to take calls.Pink lead & collarExamination: BAR, bestest doggo7.9kg BCS 4/9HR80-100 regular no murmurRR wnl, clear lungs, URT ok (very mild boas)MM pink 1-2s CRTRADIOGRAPHS:******* CLIENT EXPECTATION following RN radiograph review *******Please delete those not applicable, or otherwise highlight preferred communication.* call by CONSULTING VET when next on duty--- 03/02/2026 2:26:07 PM GW: RN comments: OA in both stifles L more than R Less muscle on L than R Likely longterm instability in stifles L worse than R --- 02/02/2026 09:27:49 GHC: CMPCV 40% - Appearance normalChem 11 normal Low ALKP of no significance--- 02/02/2026 10:08:18 GHT:Microchip added to filePremed methone / medetomidine 10mcg/kgAlfaxan induction and maintenanceMLP demonstrated L and REasier to luxate L than RNeither have demonstrable anterior drawNo joint effusionBilateral OAHips OKRN to see radsOwner reports clinically betterRecommended start zydax for OASMB STO Brett to organise discharge - was OK to start zydaxCan either pay up front or week by weekSTOL hind non weight bearing when first gets  upOner took home zydax to give at homeOn 2026-02-02, Ruby Reid underwent a general anesthesia for Sedated rads  by Dr Natalie Pyle and .PRE-SURGERY:    Drugs: Premed billed, Premed drawn up, Methone Preop (Dog) | 0.300mg/kg | 0.234ML, Medetomidine Preop | 10.000ug/kg | 0.078MG, Set up rads, IVC in. POST-SURGERY:    Drugs: Atipamezole Inj | 0.000mg/kg |. DISCHARGE:    Drugs: D/c instructions, Take home meds, Invoice finalised, D/c time | NaN |, IVC out, Bandage off. View full Chart - GA Realtime at https://api.vetcheck.it/share/AU_bdb339e7-c419-406c-80e1-c188383a0dbf--- 05/02/2026 08:39:37 NP texted owner RN commentsHi Brett & Shannon,Rob Nichol our radiology specialist has reviewed Ruby's x-rays. He agrees that osteoarthritis is present in both stifles (with the L worse than the R). It is likely that long term instability (patella luxation) has contributed to this. I suggest we reasess her progress after her course of pentosan polysulfate (Zydax) injections. Happy to discuss further when convenient.RegardsNatalieMacarthur Vets  4648 3588Dr Reid returned call - available all afternoon--- 05/02/2026 11:56:07 AM NP called Shannon Reid - message left again--- 05/02/2026 2:40:38 PM NP called again ---- 05/02/2026 3:49:40 PM SMB:OA handout sent to O--- 05/02/2026 4:54:34 PM SMB:Anaesthesia/Sedation - 04/02/2026 10:50:12 AM GHR Deferred: Called and owner not availableno answer left vm TRC Resolved ---- 02/03/2026 10:52:12 AM OB:still is limping after the injections no improvements noted    Vital Signs    Weight: 7.9;       

Reason: LimpingAppointment Notes: hx from narellan vet has been requested as per notes.last seen in Oct 2025 for difficult rising / hind limb paresis and MLPFROM NARELLAN HX1. Hindlimb paresis; mild, chronic-intermittent, progressiveMost likely secondary to bilateral grade 3/4 MPL, although cannot rule out other causes. Other differentials include softtissue (muscular, tendinous, ligamentous), partial CCL rupture, fracture, DJD (osteoarthritis, dysplasia, OCD),inflammatory (cellulitis, panosteitis, immune-mediated), infectious, myopathy, neuropathy, junctionopathy, toxins andneoplasia.Animal appears healthy, and all vitals are within normal limits.Occurring daily most times when rises after sittingNot able to jump onto seatBAR and zoomiesVacc up to dateOn monthly HWP - to check with MrReason: Slowness rising and back leg lamenessHistory:Progressive lameness LHL over 6-7 months, now dailyNot had an isse since IOP - no recall of comments when had puppy chatsLifts L leg when getting up after sitting or lying down for extended periodsImproves with movement, goes from 3-legged to walking on all 4 legs - bit stiff in gait all the time Unable to jump on bed or furniture most occasionsStill active, eating and drinking well, still has zoomiesUTD with vaccinationsMonthly HW prevention - unsure of brand - husband looks after thisLicking front paws constantlyNot had rads yet at last vet - was recommendedSpayed young - prominent nipples - was desexed before first heat Examination:BAR in consultMMs: pink & moist, CRT < 2secDental: Grade 2-3 dental dz, tartar on upper carnassialsEars: No odour or significant dischargeHR: 120Cardio: no murmur or arrhythmiaResp: Lung sounds clear, normal respiratory effortAbdo: comfortable on palpation, no palpable massesMSK: L hind - medial patella luxation palpable with bony swelling around stifle, poss medial butress - medial boney swellingNo pain on extension of stifle on L side or on attemt to demo anterior drawR hind - pain on full extension of R stifle, pain on attemp to demo anteirr draw. Patella lux poss laterally rather than medial - to check under sedation Normal proprioception both hind limbs, legs symmetrical length on extensionsIntegument: NADLNs: normalAssessment:Bilateral medial patella luxation with secondary OAGrade 3 dental dzPossible allergic dermatitis causing paw lickingPlan:Meloxicam 25mg SID with food for 7 days dispensedSedated radiographs hips and stifles scheduled Monday 8:30amDental handout information to be emailed4Cyte and Glyde supplements discussed for long-term joint supportZydax injections discussed as treatment optionConversation with owner:Owner declined dental procedure at this time, wants to address leg issue firstDental pricing information provided - Stage 1 dental $998X-ray pricing provided - sedated radiographs $850 (350 if add on to stage 1 dental)Advised fasting from 7-8pm night before procedure, water removed morning of procedurePickup time 3-7pm Monday afternoonDiscussed keeping dog lean, moderate flat exercise, avoiding hillsNatural anti-inflammatory supplements recommended for long-term managementREX scheduled post radiographsGave OA handoutConsider zydax and neutraceuticalsSedate rads booked monday    Vital Signs    Weight: 7.8;