C10007727 / invoice 10000

Reason: Lump Removed From Teeth/GumHISTORY:Had a carnassial tooth removal 2 weeks ago with a gum growth removed via cautery at the same time. Noted to be acting weird last 2 days . Today been panting, uncomfortable and in pain Current meds: None Prophylaxis: never (at least in last 10 years) Pre-existing conditions: previous OA, carnassial removal left upper 2 weeks ago. Gingival growth (epilus) removed right PM1-PM2 area 2 weeks ago Access to toxins eg. Rodenticide: None  TIME OF ARRIVAL:TRIAGE:HR: 126RR: pant Temp: 39.3Mm: pink, moist Crt: <2sec Mentation: anxious Pain Scale (1-4): 2Hydration status (%): hydration clinically adequate EXAMINATION: Body Condition Score: 6/9 Cardiovascular: No murmurs nor arrhythmia. Good femoral pulse tone and amplitude, synchronous with the heart rate Respiratory: Normal bronchovesicular sounds. No increase in respiratory effort or nasal discharge Neurological:  neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal:  discomfort along TL and Lumbar spine. Reduced ROM in bilateral hips, mild thickening on both stifle palpations. Gastrointestinal: - Oral: dental score 1/5. No halitosis or discharge. Around upper right PM1-PM2 inflammed growth (bleeding when tocuhed) - not overtly painful but maybe uncofmortable when tocuhed. - Abdominal: mild abdominal splinting - Rectal: Not performed. Urinary: Bladder small and soft Reproductive (incl ext genitalia): No abnormal findings on external genitalia examination. Integument/Ears: No significant findings. No tick found on tick search. Lymph Nodes: No significant findings. Eyes: No significant findings. PROBLEM LIST FROM PHYSICAL EXAMINATION:Spinal painNormal neurological assessment Abdominal splintingShaking/ panting/ unsettled Inflammed epiulus growth around gingival gumline - infllammatory response vs reactive (regrowth). No current signs of infection (discharge/ halitosis)DIFFERENTIAL DIAGNOSIS/ ASSESSMENT:- Differentials for spinal pain include soft tissue injury/muscular spasm, intervertebral disc disease (IVDD), discospondylitis, spinal fracture/luxation or neoplasia PLAN/DISCUSSION:Disucssed pain management regiemeOwner has recheck with local GP tomorrow - to discussed OA injections and gabapentin use for adjunctive analgesia.May represent to AES for methadone in 6 hours if starts to decline once medication wears off. TREATMENTS ADMINISTERED:1. Analgesia- methadone 0.3mg/kg SQ @ 07402. Anti-inflammatory - meloxicam 0.2mg/kg SQ @ 0740Medications for Administration at Home:1. Meloxicam Oral Suspension 30mLDose to 41kh  Mark ONCE daily ONLY WITH FOOD. CEASE MEDICATION IF VOMITING OR DIARRHOEA OCCURS & Contact your veterinarian. Next dose due MONDAY 7am (9/3)2. Fentanyl 100mcg patch. Placed @ 0740 (8/3). Active 1930 (8/3). Expires 12/3). Please read care instructions below.    Vital Signs