C10003717 / invoice 10000

Reason: Pain Under Right LegHisTory:- Presented for possible sore leg. Cried out when owner attempted to put on harness on the right side.- Owner reports an episode of crying after waking up and attempting to walk. Showed reluctance to be touched or picked up.- Observed lethargy and being "loopy" today and partially yesterday.- Jumped off the bed after the initial signs of pain, without an obvious yelp.- No known prior trauma, fall, or incident.- Diet: Biscuits in the morning, cooked meal at night, with treats in between. Did not eat breakfast this morning, reluctantly ate treats. Ate dinner normally.- No vomiting or diarrhoea reported.- Exercise tolerance: Normal walk this afternoon without issues. Did not go off-lead or have a big run.- No recent travel history.Investigation:- No previous diagnostic tests mentioned for this specific issue.Prior History:- Recently completed a course of Amoxiclav, Prednisone, and ear drops for a left ear infection and an infected anal gland approximately one week ago.- Owners report a history of anal gland issues requiring expression approximately three times since he was a puppy.- Vaccinations and parasite treatment status not discussed.Current Medications:- No current medications. Last dose of antibiotics and prednisone was one week ago.Physical Exam:Subjective: Quiet but alert and responsive. Appears anxious and shows signs of pain anticipation, particularly when being picked up.Objective: Temp: 38.4  MM: Pink CRT: <2s HR: Normal sinus rhythm, no murmurs FP: Strong and synchronous RR: Pant, eupnoeicBCS: 4/9Weight: 7.2kgPain Score (Glasgow CMPS Dog): Pain suspected but difficult to localise on exam. Vocalised when picked up but not consistent Cardiovascular: No abnormalities detected on auscultation. Strong, synchronous femoral pulses.Respiratory: Lungs clear on auscultation bilaterally.GIT: Abdomen soft and non-painful on palpation. No organomegaly or masses palpated. Rectal exam performed: left anal gland expressed a large amount of purulent material, right anal gland expressed a small amount. Mild erythema noted. No significant pain response on expression. Scooting reported at home.U/G: External genitalia appear normal.Neuro: Ambulatory with no obvious gait deficits. Conscious and appropriate mentation. No cranial nerve deficits noted.M/S: Full orthopaedic examination performed. No definitive source of pain localised. Full range of motion of all limbs did not elicit a pain response. Neck range of motion was normal and non-painful. Palpation of spine non-painful. Patellas have a slight degree of laxity but are not considered the source of acute pain (incidental finding). No swelling, crepitus or instability noted in any joint. Pain noted on palpation of left paw inconsistently, but no foreign body, swelling, erythema, or discharge found.Integ: Coat and skin in good condition. No lumps or bumps palpated. No interdigital swelling, foreign bodies or discharge noted Ophth: No abnormalities noted.LNs: Peripheral lymph nodes non-palpable.Problem List:- Acute, non-localised pain (yelping, reluctance to be handled).- Lethargy.- Inappetence (partial).- Left-sided anal sacculitis.- Suspect low grade bilateral MPLAssessment:Acute, non-specific pain. The physical examination did not localise a definitive source of the discomfort. The yelping when picked up suggests potential pain in the chest, shoulders, or spine. A soft tissue injury (sprain/strain) is possible. The expressed anal gland may have been contributing to discomfort but is unlikely the primary cause of the acute vocalisation. No evidence of fracture or major instability on clinical exam. The inconsistent reaction and anticipatory behaviour make localisation challenging.Treatment:- Methadone 0.2mg/kg administered subcutaneously in consult for analgesia.Client Communications:- Discussed the difficulty in localising the source of pain on physical exam alone. Explained that Archie may be hiding his pain.- Discussed the finding of full anal glands and expressed them, explaining this may provide some relief but is unlikely the primary cause.- Discussed the finding of slight patellar laxity as likely incidental.Options offered to client:- Option 1 (Proactive/Gold Standard): Hospitalisation for further diagnostics, including sedation, blood work (haematology, biochemistry), and radiographs of the thoracic limbs/shoulders/chest to investigate the source of pain. Cost estimate provided approx. >$1000.- Option 2 (Conservative): Trial of injectable pain relief (Methadone) and monitoring response at home. Advised to return if signs persist or worsen for further diagnostics.- Discussed that if returning within 24 hours for the same issue, the consult fee would not be repeated.Plan:- Owners elected for conservative management with injectable pain relief.- CPR Orders: Not discussed.Plan:Diagnostic plan: Monitor clinical signs at home. Re-presentation advised if no improvement or if signs worsen. Diagnostics (blood work, radiographs) to be performed upon re-presentation if needed.Therapeutic plan: Administered Methadone 1.4mg SC. Advised that it lasts 4-6 hours and may cause panting or sleepiness. No medications to go home.Discharge plan: Discharged to owners' care. Provided with instructions on what to monitor for at home (worsening lethargy, inappetence, persistent pain, new clinical signs) and when to seek immediate veterinary attention.Referral plan: No referral discussed. Owners advised they can return here or see their local vet for follow-up.    Vital Signs