C10008032 / invoice 10000

Reason: Distressed Crying Out Triage nurse:  BARo left around 12:30 and Lola seemed fine, came home this evening and she was very unsettled, panting, spinning around and would not sitnot interested in food/water or treatsPrevious history of back paino thought possible UTI 2 weeks ago but resolved on its ownthis morning went to the park and was running/playing like usualno known medical conditionsT 38.2, P100, RR pant MM pink <2 moistRecord Entered by: Charlotte Thomas - DVM 4 Student Record Checked by: Dr Isabel BrazierHistory:Lola Mok is a 4 year 5 month old female spayed labradoodle that presented to UVTHS ECC for an acute-onset of crying, panting and circling.Fine at park this morningO got home from work around 6:30pm and noticed she was crying continuously for 15 mins, pawing the owner for attention, panting and circling to the R side. O noticed in the consult room that she doesn't want to turn to the left.No previous traumatic eventBeen walking normally, no falling over or wobblinessDid not want to eat or drink tonightNo V+ or DNo seizuresDue for groomer and vet check tomorrow - gets yearly bravecto injections and vaccinationsHad a previous episode of increased frequency urinating for a few days 2 weeks ago. O’s did not notice any blood in urine or accidents around the house. O reports normal now and no PDPrevious corneal ulcer in L eye at the end of last yearHx of back pain/issue with back legs 2 years ago, given meloxicam and settledNo other medical conditionsNot on any medicationsLola is desexed Physical Examination: Demeanour: BAR, anxious, occasionally circles to the R sideBCS: 5/9EENT: Ears: visual, clear corneas, no discharge, pupils moderately dilated. Ears: stenotic and hair external ear canals, no erythema or discharge. Nose: no discharge. Teeth: grade 2/4 periodontal disease.Peripheral lymph nodes: small and symmetricalIntegument: good coat condition, no alopecia or erythema. Some urine/saliva staining around vulva.Cardiovascular: HR: 120, no murmur or arrhythmia. FPSS. Mm pink and tachy. CRT 1-2sRespiratory: Panting, normal bronchovesicular soundsAbdominal: soft and comfortable on palpationMusculoskeletal: No signs of lameness or ataxia. No pain on palpation and flexion/extension of limbs. No pain on palpation of vertebrae. Painful (vocalising repeatably) and resistant to L lateral movement of the neck - barely able to move at all to L lateral.Neurological: Face musculature symmetrical, no head tilt. Palpebral and PLR present. Pupils symmetrical.  Difficult to determine whether Lola could follow the cotton ball, but menace response present. No nystagmus or strabismus.Tongue tone present. Proprioception present in all 4 limbs. Rectal: normal firm faeces presentUrogenital: bladder soft and moderate sizeAssessment:Lola showed signs of pain (yelped, resistance) to L lateral movement of her neck. This is most likely due to cervical soft tissue injury or IVDD, however, fractures, neoplasia or an inflammatory/infectious disease cannot be ruled out at this stage without further imaging. Being unsettled and crying is fairly non-specific, although most likely associated with Lola’s neck pain. Circling towards the R side could be due to discomfort turning to the L or less likely due to intracranial or vestibular cochlear disease as the neurological examination was normal other than the circling to the R - which seemed to be more voluntarily due to pain rather than involuntaryTreatment: Methadone 0.5ml (0.2mg/kg) IM Meloxicam 0.9ml (0.2mg/kg) SC  Plan (incl. alternative options): - TGH with meloxicam 0.1mg/kg (1.5ml BID with food) for 5 days, starting from tomorrow evening- Rest for next week - avoid walks, playing and stairs- Elevate food to minimise neck strain- Represent tomorrow if not showing any improvement in clinical signs (e.G.Circling)- review immediately overnight if any further neuro signs occur or have concerns    Vital Signs    Weight: 22.3;