C10000802 / invoice 10000

Patient Information:
- Harley, Dog, 14 years old, Male

Reason:
- Whimpering at night, unsteadiness on waking

History:
- Whimpering/crying at night, noticed this week (mid-week)
- Unsteady on feet when waking from sleep, holds up front leg, head down
- Takes a couple of minutes to correct himself then fine
- Sometimes looks unsure what's going on
- No seizures or collapsing
- Still eating and drinking well
- No vomiting or diarrhoea
- Still toileting appropriately, uses doggy door
- Has slowed down significantly
- Owner concerned about possible cognitive decline vs arthritis
- Has yelped when lifted in the past
- Multiple skin tags present for years, bleeding, self-traumatising (bites and scratches)
- Previous skin tag removals performed
- Previous ear infection treated with abx
- Bathing weekly with medicated shampoo
- ALP mildly elevated at 135 (top normal 150) in July 2025
- Owner going away Monday for one week, mother-in-law caring for Harley

Examination:
Mentation: BAR
BCS (0-5): 
mm: pmg               CRT: <2s
HR:                  RR: normal
Ln: 
Dental Grade: Poor, multiple teeth affected
Temp: 
Heart/lungs: NAD. Abdomen: NAD.

- Coat thinner than expected
- Multiple skin tags present, some appear infected, weeping
- Grade 1 heart murmur noted
- Unsteady gait observed on examination
- No head tilt, no rolling

Assessment:
1. Suspected arthritis vs cognitive decline
- Front leg being held up, whimpering at night may indicate pain
- Could also be disorientation on waking
- Cushing's disease discussed as differential given panting, coat changes, age, breed; however appetite not excessive, urination not increased
- Old dog vestibular disease discussed but no head tilt or rolling, symptoms ongoing rather than episodic
- Repeat bloods offered to check ALP and assess for Cushing's if elevated further
- Owner to take video of episodes when they occur
- Quality of life discussion if cognitive decline progresses

2. Infected skin tags
- Multiple skin tags bleeding and weeping
- Self-traumatising behaviour
- Previous abx did not resolve
- Surgery not recommended due to age

Treatment:
- Anti-inflammatory tablets half tablet twice daily for one week
- Mediderm or Malaseb shampoo for weekly bathing

Plan:
- Pain trial with anti-inflammatories for one week
- If improved, can dispense more on return
- Monitor for improvement or decline
- Owner to take video of episodes
- Repeat bloods if desired to reassess ALP and check for Cushing's
- Gabapentin can be considered in future if needed for sleep/nighttime settling
- Cu if worse

Courtesy Phone Call
Nurse: LH
Reason: sore ear
EDUF: all fine
Taking medication as prescribed? Yes
Revisit required? o will call to book RV but more likely to monitor at home as insurance cut off reached