C10004875 / invoice 10000

07/03/2026 DATE/TIME of CONSULTATION: 07:42hrs, Sat 07/03/26
CLINICIAN: EH 

PRESENTING COMPLAINT:

HISTORY:
Unable to walk overnight 
Passed a stool in waiting room 
Dragging hindlimbs - First episode of hindlimb weakness 
Nil vomiting or diarrhoea 
Eating last night 

Fasted this morning. 

Medications: Meloxicam LD 6pm 6/3 

CLINICAL FINDINGS: Mentation: HR: 140bpm, nil murmur or arrhythmia appreciated
 RR: 32brpm, normal effort and pattern
MM: pink, moist 
CRT: <2s 
Temp 38.3

Neurological examination:
Forelimbs normal
UMN hind limbs - brisk reflexes bilaterally (patella, CT)
Moderate bladder on palpation
CP RH negative, present LH
Non ambulatory 
weak VMF present bilaterally 
LH some weak CP present; absent right hind
Cutaneous trunci cut off around T13 approx
Deep pain present in both hind 

Advised owner we are concerned that Bruno has Intervetertebral Disc Disease causing paresis/paralysis of the affected limbs. That confirmation of a diagnosis would involve an anaesthetic, CT scan and possibly a myelogram or CSF tap to distinguish between IVDD and other differentials (GME, neoplasia, meningitis, FCE). 
That treatment varies on the grade, but surgery may be required. 
The prognosis varies, but generally grade I-IV IVDD has a 90% chance of return to normal function. Patients with no deep pain, grade V, have a 50% chance a higher risk of ascending myelomalacia.

There is a risk of
- Poor return to function 
- Anaesthetic for an otherwise well patient (1:10,000)
- Ascending myelomalacia (1%)
- Wound infection (1-2%)
- Seizure or sudden death associated with myelogram
- Further disc prolapse in future (5-10%)

The owners have decided that they would like to proceed with CT, myelogram and surgery if indicated. 

Biochem: 
ALT 188 H 
Creat 40 L 
CRP WNL 2
EPOC Na 151 otherwise WNL

DIAGNOSIS:
Likely IVDD - referral to surgery for imaging +/- surgery

TREATMENT:
1/ Methadone 0.2mg/kg IV q4hr 
2/ IVFT hartmans 2.5ml/kg/hr 

CLIENT COMMUNICATION/PLAN: Texted owners to let them know that surgery team had taken over care and were heading into CT now and would call afterwards for next steps. 


07/03/2026 KH notes
Neuro exam - Normal mentation, QAR, no cranial nerve or forelimb abnormalities detected. When supported into a standing position Bruno demonstrates limited voluntary motor function in the left hind, swinging the limb forwards and placing the foot correctly, but unable to maintain extensor tone for weight bearing. No voluntary movement evident in the right hind. Patella and withdrawal reflexes intact, deep pain present bilaterally. Panniculus reflex brisk to the level of the last rib, then diminishes symmetrically until absent at the level of the mid lumbar spine. No clear focus of pain upon palpating along the spine. 

Plain CT consistent with recent disc extrusion and haemorrhage at the level of the T12-T13 disc space on the left
Discussed options of surgery vs conservative management with the owner, she is keen to proceed with surgery
Left dorsolateral approach to the spine at the level of the T12-T13 disc, pediculectomy performed and plenty of fresh disc material and haemorrhage removed. No sinus bleeding encountered. Good view of the spinal cord at the end of surgery. 
Closed routinely in layers with 2/0 PDS in the fascia and 4/0 PDS intradermal to close the skin

Updated o. She explained it is very normal for him to 'snore like a freight train' when he's asleep at home so don't let this be a cause for concern!



Post-op PLAN:
MEDICATIONS: 
*Gabapentin 100mg PO BID for 14 days
*Continue Meloxicam at home SID 
SUTURES: intradermal skin suture
BANDAGE/CAST: Primapore over suture site
REST: 4 weeks strict crate rest
REVISIT: 10-14 days for suture removal and Neuro check
OTHER:

NURSE: VL
SURGERY / PROCEDURE: CT and spinal decompression at T12-13 on the LEFT
PREMED: Medetomidine 0.005mg/kg & Methadone 0.3mg/kg @ 11:26 IV
ANAESTHETIC: Alfaxan 0.5mg/kg IV @ 11:30 then maintained on Isoflurane / Oxygen
FLUIDS: Hartmanns 5ml/kg/hr 
PERIOPERATIVE ANALGESIA:
      1. FLK CRI 1-2ml/kg/hr
FENTANYL PATCH: Durogesic  12ug    
PERIOPERATIVE ANTIBIOTICS: Cephazolin 22mg/kg
PERIOPERATIVE DRUGS:
IMAGING: CT whole spine on T-L setting
NOTES: 
OTHER:  

08/03/2026 ******************DAY SHIFT UPDATE****************
PROBLEM LIST:

CLINICIAN: EH 

EXAMINATION:
BAR 
HR 100bpm, no murmur or arrhythmia appreciated 
Femoral pulses strong, synchronous 
Incision covered with primapore, nil strikethrough
Abdominal palpation soft, small bladder palpable 

Urinated in cage - not seen to pass urine in AM 
No interest in food on shift

Neurological exam:
- CP negative bilaterally 
- Deep pain present bilaterally 
- VMF weak but present bilaterally, unable to walk or stand 
- No cutaneous trunci deficits present 

ASSESSMENT:
1/ Day 1 post T12-13 hemilaminectomy LHS 
- Grade 3 post op 
PLAN:
Fluid plan:
Analgesia:
Nutrition Plan:
Monitoring:
- Recheck PCV/TP, EPOC, q24
- Monitor blood pressure q12
-
-

Discharge Criteria
- Pain managed
- Eating without assistance
- Clinically bright

CLIENT COMMUNICATION:
OWNER UPDATED re ACCOUNT:
CURRENT ACCOUNT BALANCE:


******************NIGHT SHIFT UPDATE****************
CLINICIAN:
EXAMINATION:
DIAGNOSTIC TESTS:
ASSESSMENT:
PLAN:
Fluid plan:
Analgesia:
Nutrition Plan:
Monitoring:
- Recheck PCV/TP, EPOC, q24
- Monitor blood pressure q12
-
-

Discharge Criteria
- Pain managed
- Eating without assistance
- Clinically bright

CLIENT COMMUNICATION: