C10008633 / invoice 10000

NURSE:NA
HISTORY:been limping for 4 days . on a walk and pulled up lame
EDFU normal
-Diet black hawk and prime 100 
-Env indoor outdoor
-Comp Jampa
-Prev nexgard spectra
Current Meds:nil
-Insurance?
SUBJECTIVE: BAR
OBJECTIVE: T=  MM pink CRT <2sec HR 104 = FP RR panting RESP:NAD
BEHAVIOUR ASSESSMENT:miserable
BCS: 5/9
GIT:NAD
U/G:NAD
NEURO: NAD
M/S: RF grade 4 /5 lameness , painful proximal to elbow. still weight bearing. 
can flex elbow. NAD distal to elbow. 
SKIN: NAD
OPHTH:NAD
OTIC: NAD
LYMPH/N:
ASSESSMENT: right forelimb lameness - suspect neoplastic, less likely 
Tx OPTIONS:
TREATMENT:meloxicam 2.6ml and  buprenorphine  0.72mg SQ
codeine 60-90mg up to 4 hoursly as needed for pain
warned of drowsiness
meloxicam 2.5ml sid
PLAN:Xrays under GA with CVC on Tuesday or to MASH earlier if is not comfortable or becomes nonweight bearing 
DISCUSSION:
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DISCHARGE
Karuna has been very lame on her right front leg for a few days. She  may have just injured herself but she is not showing signs of recovery. She is painful when examined on her humerus ( upper arm) . We are concerned there may be a tumour in her bone. If she stops weight bearing at all on that leg she should be seen by a vet as soon as possible otherwise we have booked her in for a recheck early Tuesday with the plan to admit her for XRays under anaesthetic if her leg has not show significant improvement. 
She has some pain relief to go home which should be given as directed. The codeine can be added in if you feel the meloxicam is not enough. 
One of the injections will make her drowsy as will the codeine tablets. 
Please read and follow the pre surgery information to help you prepare her for Xrays on Tuesday should we proceed with this. 
 If you have any concerns or queries please do not hesitate to contact the clinic 

NURSE: Jessie
HISTORY: been well, due for C5, went to boarding for 2 wks
EDFU all normal
-Diet Black hawk
-Env in+out
-Comp brother
-Prev nexgard spectra and tape worm
Current Meds: nil
-Insurance?
SUBJECTIVE: BAR
OBJECTIVE: T= 38.2 MM pink CRT 2sec HR = 96 FP RR  RESP:
BEHAVIOUR ASSESSMENT: 
BCS: /9
GIT:G1 DD
U/G: -
NEURO: 
M/S: 
SKIN: 
OPHTH
OTIC: 
LYMPH/N:
ASSESSMENT:
Tx OPTIONS:
TREATMENT:
PLAN:
DISCUSSION:
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DISCHARGE