C10001671 / invoice 10000

AT TTPO, unable to leave message at 11.40am as Owners requested a phone call regarding Nelson's limping.
Spoke to Owners later. They wish a referral to WAVES and more Carprofen dispensed.
Both done by AT

Reason: Courtesy phone call post-surgery/ procedure
Nurse:rh-ttponalm
History:post castrate

O called back, doing well, drinking water, eating handfuls of kibble, had to give meds with cheese
Hasn't had a wee or poo yet, not heavily concerned as still recovering from anaesthetic and was fasted yesterday, O will monitor for today, understands she can head to another vet or emergency tomorrow if need be.

- CB

Reason/concerns:  Admit with vet for procedure

History:
Sarah and Joshua came in today
O noted occasional limping last 2 months - last week getting worse or obvious
Elbow dysplasia and arthroscopy on L elbow 1 yr ago
Base on movie O shown, down on the LFL - Limping/Sore on the RFL
O noted Nelson gained weight, very boisterous and difficult to walk him sometimes due to his size and demeanor - would like to have some advise
EDUF normal with good appetite
Diet Hypoallergenic diet

Pre-exisitng Conditions / Medications:
4cyte daily since elbow dysplasia procedure 1 yr ago
Gabapentin 1200mg 2 hours prior
Trazodone 300mg 2 hours prior vet visit

*Anxious if getting close for PEx, towel covering sight seems work well*
Examine: 
Mentation: BAR
BCS: 5/9
MM: Pink moist          
CRT: NE
HR: 80 beats/min
RR: 30 breaths/min
Temperature: NE

Ocular: No abnormalities noted on cursory examination of both eyes.
Oral/Dental stage: unable to assess due to oral shy
Ears: No abnormalities noted on cursory examination of both ears.
Cardiovascular: No audible murmur or arrhythmia and no difficulty hearing the heart. HR = PR and no evidence of hypoperfusion.
Respiratory: Respiratory rate and effort considered normal for the patient.
Gastrointestinal: NE
Integumentary: Smooth coat
Musculoskeletal: Normal gait and strength noted. No evidence of lameness in consult
Urogenital: 2 descended testicles
Neurological: No evidence of neurological impairment or altered mentation. Detailed neurological examination not performed today.
Lymph nodes: Within normal limits for mandibular, prescapular and popliteal examination.

Problem List:
Limping on the RFL (base on movie shown) - Elbow dysplasia, secondary arthritis to it?

Patient Assessment: 
standing up quite often in consult room, no aggression shown
anxious when coming in close for PEx - towel covering head worked well

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MSK exam in treatment room after Nelson received pre-med
- LFL elbow seems normal with in size and contour
- RFL elbow, cranial part of radius and ulna thickening noted - suspect elbow dysplasia due to LFL history
- HLs normal, good hip ROM

Diagnostics performed (i.e. bloods, radiographs/ultrasound, ear cytology, urinalysis):
- None performed 

Check surgery note below