C10006963 / invoice 10000

Reason: LimpingAppointment Notes: O phoned this morning aware of weekend surcharge - Cookie limping badly after/during walk. CKHistory: RFL nwb lame Sudden onsetHistory:Presenting for: Tibetan spaniel presented for acute onset non-weight bearing lameness of the right forelimb with sudden onset while tied up outside a coffee shopDiet: Normal appetiteCurrent Meds: Previously had Meloxicam tablets, currently noneOther: Dog was normal when walked to coffee shop, owner went inside for a few minutes, came out and dog was non-weight bearing lame on right forelimb. No known trauma, not picked up by forelegs, doesn't stress when tied up. Very placid dog that doesn't run up and down stairs anymore.Examination:Mentation: BARBehavioural: Cooperative during examinationEyes: NormalCardiovascular: Normal heart soundsMusculoskeletal: Non-weight bearing lameness right forelimb. Normal flexion of carpus joint, normal medial-lateral stability. Absent internal rotation of right elbow - right foreleg stops partway across chest compared to normal left side. Significant muscle tension through upper shoulder and elbow region. Swelling present in right antebrachium. Restricted shoulder extension. Some muscle tension in lower neck, likely referred pain. Good deep pain sensation, able to bear some weight by end of examination.Neurologic: Good head and neck mobility, no signs of disc disease. Normal deep pain sensation. No knuckling of feet.Assessment:Right forelimb lameness - DDx: soft tissue injury to shoulder/elbow region, possible dislocation that has reduced with muscle/ligament inflammation, disc disease (less likely given normal neurological exam)Plan:New Meds/Tx:- Meloxicam injection given subcutaneously today, lasts 24 hours- Meloxicam liquid 0.46mL once daily with dinner starting Sunday night for 2-3 days. Stop immediately if any gastrointestinal upset, diarrhoea, or loss of appetite occursAdditional Discussion:- Strict cage rest for weekend - no walks except for toileting, no jumping on/off furniture, carry up/down stairs and in/out of car- Monitor for neurological deterioration including knuckling of feet which would indicate disc disease requiring emergency care- If comfortable by 1pm today, continue conservative management over weekend- If still painful by 12:45pm today, return for sedation and radiographs (window available 1-5pm today)Client Comms:- Recheck appointment Monday regardless of improvement to assess progress- If still sore Monday, will perform radiographs or consider laser therapy- Contact clinic if any deterioration or if not improved by 1pm today    Vital Signs    Weight: 7;