C10009933 / invoice 10000

Reason: Left Front X Ray History: Seen by BK last week- sore L FL, suspected carpal in natureOs report that no significant improvement noted on meloxicam over the weekendExamination: BARHR 80; sinus rhythm, no murmurMSK - Very slight lameness at walk- ~1/5 on LFL. Crepitus & pain response on palpation of L carpus (head turning, lip licking, huffing). No palpable changes to region however. Placing of both forelimbs wnl.Assessment: Recommend x-rays- would like to r/o OSA given location (as well as f# or other boney pathology)Pre-GAs recommended as senior dog- ALP elevated - 433 (n 20 - 150)- rest of Pre-GAs unremarkableTreatment: R cephalic catheterised with 22GSedated w 0.4ml medetomidine, 0.8ml butorphanol IV3x views of L carpal region taken (54kV, 6.4mAs) - DV, lateral & flexed lateral- no obvious indicators of aggressive lesions noted (lysis, proliferation etc)- no fractures notedBK spoke to Dave- discussed lack of findings radiographically. Rec sending to specialist for interpretation & increasing analgesia in interim. INI, and no answer via rads, happy to refer for CTMedication: Continue 0.1mg/kg metacam po sidCommence 500mg gabapentin po bidCommence 600mg paracetomol po bidPlan: Pending radiologist interpretation of radsAssess response to increased analgesia    Vital Signs