C10011321 / invoice 10000

• FL lameness, recent onset.• Review of CT findings (elbows & lumbosacral spine).History:• Rescued at 1 year of age. First dog for current owners.• Prior vet physical examination identified hip problems, no imaging performed at that time.• Presenting complaint is FL lameness, noticed a few weeks ago. More noticeable after rest/rising, improves after 3-4 steps.• No apparent issues with hindlimbs, able to jump.• Reluctant to jump into SUV but does so without vocalising pain.• Generally healthy otherwise.• Previous vet suggested long-term meloxicam and gabapentin. Owner has administered 3 doses of meloxicam.• Desexed female.Vaccination:• UTD.Diet:• Not specified.Preventatives:• Not specified.Microchip:• Not specified.Medication:• Meloxicam prn.Examination:• General BAR, friendly demeanour.• BCS Wt 35kg. Previously 38kg, likely scale variation. Stable at 35kg for a long time. Recommend weight loss.• Eyes NAD.• Ears NAD.• MM NAD.• Hydration NAD.• Dentition NAD.• Cardio NAD.• Resp NAD.• Abdo Soft, non-painful.• Urogenital NAD.• MSK Subtle LFL. Leans away, taking weight off L side. Pain on palpation of both elbows, more pronounced with subtle extension. Mild discomfort on pressure over lumbosacral region. Slight swelling noted in both stifles, L>R, with discomfort on palpation.• Neuro NAD.• Skin NAD.• LN NAD.• Temp NAD.Assessment:• Bilateral elbow dysplasia with secondary osteoarthritis (OA), L>R.• Lumbosacral (L6-7) disc bulge with possible nerve root impingement and associated pain. CT findings may not correlate with clinical signs.• Early-stage bilateral cranial cruciate ligament disease suspected.Client communication:Discussed CT findings for both elbows and lumbosacral spine. Explained that elbow OA is a common consequence of elbow dysplasia in this breed and is a significant cause of morbidity. The left elbow shows more chronic arthritic changes, and a potential undisplaced fragment on the coronoid process. The right elbow also has a fragment identified on CT. Explained that elbow OA is difficult to manage surgically, with limited and high-risk options such as partial/total joint replacements. Discussed arthroscopy as a diagnostic tool to assess the extent of cartilage damage and to debride any loose fragments, with the caveat that clinical improvement is not guaranteed.Discussed the lumbosacral findings, including the L6-7 disc bulge and transitional vertebra. Explained that many German Shepherds have abnormal lumbosacral imaging without clinical signs. While Coco shows mild pain on palpation, the clinical signs are not severe enough to warrant aggressive intervention like epidural steroid injections or surgery at this stage. Discussed that an MRI would likely not add significant information over the CT scan, and dynamic CT studies (flexion/extension) would be more useful if pursuing further diagnostics for the spine.Discussed management options. The primary recommendation is a conservative approach focusing on weight loss, exercise modification, and medical management. Advised a target weight of 32-33kg (approx. 11% reduction) to be achieved over 2-3 months. Recommended specific weight loss diets and regular weigh-ins. Advised moderation of exercise to lead walks and swimming, avoiding high-impact activities like chasing balls or rough play with other dogs. Discussed medical options including NSAIDs (meloxicam) as the mainstay for OA pain, and the potential role of nutraceuticals (fish oils, glucosamine/chondroitin), though evidence for their efficacy is limited. Other options for refractory pain were mentioned, including intra-articular injections (steroids, PRP, stem cells), but these are not first-line.The owner opted for a conservative management trial. We agreed to reassess in 2-3 months. Arthroscopy would be considered if lameness persists or worsens despite conservative management. Estimated cost for bilateral elbow arthroscopy and repeat CT imaging is approximately $5,000-5,500. Advised that insurance may consider the elbow and back issues as two separate problems, potentially requiring two excess payments.Treatment:• Dispensed Meloxicam oral suspension.Plan:• Weight loss program to a target weight of 32-33kg over 3 months.• Exercise modification: lead walks only, avoid high-impact activities for at least 4-6 weeks.• Administer Meloxicam daily for 2-3 weeks, then as needed.• Monitor for any sudden worsening of lameness, particularly in the LFL, which may indicate a fragment has displaced.• Monitor for development of hindlimb lameness, which could be related to cruciate disease.• Re-evaluate in 2-3 months, or sooner if clinical signs worsen.• If lameness persists, consider bilateral elbow arthroscopy and potential dynamic CT of the lumbosacral spine.• Owner to contact clinic to schedule follow-up or if concerns arise.    Vital Signs