C10006957 / invoice 10000

Appointment Notes: Recheck with km - nk  ------- Sms reply: YPresenting Complaint: Hugo Flynn presents for ongoing pain episodes despite current pain managementPatient History:- Currently on gabapentin 200mg BID and metacam (last dose of latter was last night)- - Episodes characterized by sudden onset of pain, yelping, and hiding behaviour- Had a great day yesterday following increasing gaba dose  & avoiding ramp use. However, this morning: charged outside after breakfast, defecated, then yelped and hid in media room. Jen describes this more of a 'feels pain, then defecates while outside, doesn't think the defecation is causing the pain'- Previous episode: yelped after eating frozen blueberries on empty stomach, so thinking may be gut pain- Previously yelped when being lifted/moved, now improved on pain relief- Occasionally consumes duck faeces from yard. Jen is strict and is pretty sure does not consume any cat faeces.- Showing interest in walks but client has avoided them- Only doing partial body shakes and stretches, suggesting neck discomfort is still present- Not sure if can fit in travel for CT scan  given own medical appointments over next week or soProblem List:- Cervical pain with neurological signs - r/o meningitis, cervical disc disease, inflammatory CNS condition- Incomplete defecation - r/o pain-related reluctance, positioning difficulty, constipationDiagnostics:- CRP to assess for inflammatory processTreatment Plan/Medications:- Continue gabapentin 200mg BID- Discontinue metacam for 2 days (Monday and Tuesday)- Rx: Prednisolone to start Wednesday - will confirm when ring with CRP results- Consider CSF tap if no response to prednisolone trial. Discussed doing this here, but I would not guarantee I would get a good yield as not efficient at this, though have done before.  Client Communication:- Discussed potential infectious causes (toxoplasmosis, neospora) - Explained difference between inflammatory vs musculoskeletal causes- Discussed referral to SASH for CT scan and CSF tap under anaesthesia if prednisolone trial unsuccessful - Advised that prednisolone may suppress diagnostic test results if given before CSF tap- Approved short walks with harness if patient shows interestCRP: < 10.0mg/LNot strongly suggestive of a meningitis, esp an infectious cause. Still trial pred and see if get a better response than metacam.... if not can switch back. Stay on gabapentin    Vital Signs    Weight: 7.6;       MMColour: Pink;       HeartRate: 128;       MusculoSkeletal: Abnormal (No sharp pain reaction but definitely sensitive to palpation along lumbar spine. Exaggerated dip and sits esp from mid to caudal lumbar. );       Neck: Abnormal (Yelped with sharp turn of neck to left. (Was to the right on last exam));       Abdomen: Abnormal (2 large faecal balls palpable in distal colon - one at pelvic inlet and another slightly orally. Jen says is due for his second poo of the day and hasn't been having any trouble passing these, so not concerned);       Demeanour: BAR;       Temperature: 38.9;       CRT: 1-2;