C10001197 / invoice 10000

Reason: LameClient Present:jodieNurse:if yes, Gaponly claim required today? Y / NClient requests +/- concerns:Additional nurse notes:__________________________________________________________________________HISTORY:Piper presents for acute pain. Owner reports she has been slightly off for the last few days. Given meloxicam yesterday due to previous chronic flares of both patellas and prior spinal injuries. Today when lifting her, she twisted and yelped and has been uncomfortable since.Current meds: meloxicamVaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: chronic patellar flares, prior spinal injuriesAccess to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 1Hydration status (%): euhydratedCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: delayed proprioception deficits in both forelimbs, right more significant than left, alert and brightMusculoskeletal: pain at thoracic level of spine, no palpable neck pain, ambulating with weakness and general paresis in hind legs, able to stand but criss-crossing back legs on walk, general weakness in hind legsGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): not graded- Abdominal: not performed- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: BARPROBLEM LIST:Acute spinal painNeurological deficits - delayed proprioception both hindlimbsHind limb weakness and paresisCriss-crossing gaitDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:None explicitly mentionedDIAGNOSTICS:NoneASSESSMENT:Acute spinal pain at thoracic level with neurological deficits including delayed proprioception in forelimbs and hind limb weakness with abnormal gaitTREATMENT:Strict crate rest for 2-3 weeksContinue meloxicamGabapentin 50mg twice daily (one tablet twice daily) for nerve pain and anxiolytic effectPLAN:Owner to consider SASH emergency tonight if proceeding with surgeryAlternative conservative management with pain reliefMonitor clinical signsCLIENT COMMUNICATION:Discussed surgical option via SASH emergency or conservative management with pain relief and monitoring of clinical signs    Vital Signs    Weight: 3.75;