C10010181 / invoice 10000

Reason: Blood Test. DAAppointment Notes: Overdue remindersReason: History: Examination: Laboratory: Assessment: Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:    Vital Signs    

Reason: TAHP ResultsLaboratory: TAHP:- CBC: sample was clotted- Biochem: mild hypercholesterolaemia at 8.0 mmol/L (2.2 - 5.5), moderately elevated CK at 2698 IU/L (64 - 400)- Lytes: all WNL- TT4: normal at 32 nmol/L (10 - 60)Assessment: Mild hypercholesterolaemia - DDx post-prandial (most likely) vs less likely pancreatitis, liver or kidney disease (no evidence of these)Moderately elevated CK - likely secondary to venipuncture, much less likely due to muscle inflammation/infection, a true myopathy, toxin, etcPlan: Bring back with gabapentin on board for redraw of CBC (no charge) and CK - fine for a nurse to doClient communication: Rang and spoke to the owner - advised: - blood work mostly normal - mildly elevated cholesterol - likely secondary to having eaten prior to blood draw - moderately elevated CK - likely due to slightly difficult blood draw, but might be worth rechecking since it is moderately elevated rather than only mildly up - unfortunately no CBC as blood clotted - need to redraw - recommend owner brings Tiny back in for a nurse consult in the next 1-2 weeks with pre-vet gabapentin for a redraw for CBC + we will recheck the CK at the same timeOwner very happy with the above plan - will call to book the nurse consult**WHEN OWNER BRINGS TINY IN FOR THE REDRAW:**1. Take blood for a CBC and submit to IDEXX as part of the previous TAHP - quote the order ID number: 30010693072. Take blood for an in-house CK3. Put into the path follow up list for me to follow up with the owner when results are back    Vital Signs    

Reason: Recheck Abnormal Gait +/- Do Blood WorkHistory:Reason for consultation:- Recheck examination for an abnormal hindlimb gait.Owner Reports:- Owner noticed an abnormal hindlimb gait ("swaying") about 3 weeks ago now - seems to be present constantly. Possible the gait has been happening for longer and was not noticed.- Does also trip over her own feet intermittently when running up stairs - has done this for a long time but owner did not really think much of it until recently.- Does not appear to be painful at all. Jumps up and down normally and is never lame.- Appetite, thirst, urination, and defecation are all normal.- No vomiting, diarrhoea, coughing or sneezing.Other Health Information:- Meds: Nil.- Has a Hx of asthma - is on fluticasone BID. Well-controlled.**Videos on file:**- 2 videos taken recently - show a "waddling/swaying" type gait in the hind limbs where both swing outward slightly and her pelvis sways from side to side - very regular gait- 1 video from Dec 2024 - shows a similar gait to the other 2 videos taken recently but is much less pronouncedExamination:Temperament: Timid but very friendly.BCS: 4/9 (on the leaner side, weight is being monitored).Abdomen: Medium-sized soft bladder. Normal feeling faeces palpable in the descending colon. Otherwise, soft and comfortable on palpation, no obvious organomegaly or masses felt.Musculoskeletal and Neurological:  1. No pain on palpation along the spine.   2. Good ROM on neck manipulation with no signs of pain.   3. No pain on flexion or extension of stifles and hips. Able to achieve full hip extension, though pulls back on hyperextension of stifles/hips.   4. Grade 2/4 MPLs bilaterally, most evident when stifles are hyperextended; patellas return to trochlear groove on flexion.   5. Slightly crouched when walking around consult (consistent with cat in a new environment) but no lameness or ataxia seen.   6. Normal conscious proprioception in all four limbs.   7. Normal reaching reflexes in forelimbs and hindlimbs.   8. Jumped off couch, reached slightly but landed normally. Did a normal hindlimb stretch during consult.Laboratory:- Blood sample collected for Total Annual Health ProfileAssessment:1. Bilateral grade 2/4 MPL2. Abnormal hindlimb gait - Chronic (present since at least December 2024) but has worsened- DDx due to a musculoskeletal disorder (more likely), such as secondary to bilateral grade 2/4 MPL, an angular limb deformity, etc) vs less likely due to a neurological disease, such as spinal lymphoma, infectious meningitis, etc.Treatment:Nil.Plan:1. Abnormal hindlimb gait- Discussed case with both Dr Sue in neuro and Dr Tesh in sx:  - Dr Sue felt the gait was very regular and looked more musculoskeletal.   - Dr Tesh assessed patellas, hips, etc - advised of bilateral grade 2 MPL , mostly on hyperextension. MPL could be causing abnormal gait, especially if there is also an angular limb deformity. Unlikely to be surgical at this stage and does not seem to be causing pain/affecting QoL.- Advised owner of the above - abnormal gait appears more musculoskeletal than neuro. Cause unknown but could be secondary to bilateral MPL especially if there is also an underlying angular limb deformity.- Options discussed:    1. Monitor for any worsening of the gait. If any worsening, then proceed with #2.    2. Proceed with referral to an orthopaedic surgeon for further assessment and diagnostic imaging (radiographs of hips, pelvis, stifles) to investigate for angular limb deformities.- Owner elects for #1 - advised to continue monitoring the gait. If it worsens, referral to an orthopaedic surgeon for a consult and radiographs will be pursued.- Will do blood work today just to assess overall health and rule out any metabolic diseases. I will call with blood results when available (likely tomorrow).    Vital Signs