C10001370 / invoice 10000

Reason: ongoing exercise intolerance/pain/lethargy issues  

History: When O picks up by chest tends to yelp, wont go up or down kerbs, won't roll in grass, not able for as long a walk
last 2 weeks, O gave paracetamol last night but hasn't been using them otherwise

Vac/Parasites:
UTD / not asked
Current meds: 
paracetamol last night
Mentation: BAR
Body condition score:     6/9 above ideal
CRT/HR/RR/Temp/LN
Pink <2secs/ normal/normal/normal/nad

Ocular:
Oral/Dental: stage
Ears: ne
Cardiovascular: nad
Respiratory: nad
Gastrointestinal: abdo palp reveals large organ mid abdomen, spleen? feels soft 
Integumentary & lumps: nad
Musculoskeletal: yelped on end of extension of left hip
no lameness on walking into consult
no pain on attempting cranial drawer left stifle
slight discomfort along spine?
rest of joints moving ok
Urogenital: ne
Neurological: nad

Problem List:
msk pain?
splenomegaly?
spinal pain?
Assessment: 
is the lethargy a msk issue or other
reasonable to trial on nsaids and then reassess
Treatment: 
nsaids
Plan:
recheck in 3-4 weeks if improvement on nsaids consider pentosan, WET therapy, continueing nsaids - advise bloods in this scenario, +/- xray of hips

TTPONALM @11.30 about the CP notes.
Plan: trial with nsaid (meloxicam 0.5ml (dosed at 8kg as sl overwt) sid for 7d) vs paracetamol (125mg q12h for 5-7d) vs monitoring

TTPONALM @1.30pm

O called back @4pm. O said yesterday afternoon after going home, was a bit lethargic still, not going to O for snacks etc which is unlike his usual behaviour
this morning when O brought P for walk, not too keen as well, which is unlike him and didnt want to walk too far. 
appears to be a bit better this afternoon, O opted for monitoring for now. Sent sms for paracetamol dose to O to have on standby if P is sore.

Reason: Courtesy phone call 
Nurse: OA
History: Reluctant to walk
     Demeanour: BAR
     Eating/ Drinking: normal
     Toileting: normal
     Any concerns? still the same on LHL
     
Treatment:
     Medications being given: nil
     Patient taking meds as prescribed? n/a

Assessment:
- O advised P was a little lethargic/tired all afternoon yesterday
- This morning seems to have picked up and brighter
- O took him for walks this morning, still seems reluctant to walk
- O said still the same as yesterday morning
- Advised will let vet know and get back to her
- Advised to monitor for now and call if worsen

Next Appointment: tbc