C10012259 / invoice 10000

History: - taken for shower yesterday at home, afterwards was limping on left hindlimb- progressed to her not wanting to move, was toe touching afterwards- on pandadol oesto and gabapenin for arthritis - cytopoint for skinHISTORY:Presents for acute onset weight bearing lameness of the left hindlimb. No known trauma event prior to this. Owner was reportedly washing Maddy in the shower yesterday and notcied that she was limping shortly after. The lameness has now progressivelty worsned over the last several hours to the point where she was reluctant to move and has to be coaxed and lifted to stand for toileting. Overnight and this morning she now requires assistance to go outside. Once up and moving she can walk though she prefers not to place weight on the affected leg. Previous history of arthritis and has been on paracetamol and gabapentin for about 12mths now. Also has skin issues which she receives cytopoint for. Current meds: Panadol Osteo (paracetamol 625mg) SID as needed (last dose this morning), gabapentin 300mg in morning and 600mg in evening, cytopoint monthlyPre-existing conditions: arthritis, skin sensitivityAccess to toxins: None SUBJECTIVE:- BAROBJECTIVE:Temp: 38.6           MM: pink             CRT: <2            HR: 132            FP: normokinetic and synchronous             RR: pantingBCS:    8/9                Wgt:   44 kg  CV: no obvious cardiac murmur how difficult to fully assess over body condition and panting, normal rhythmRESP: clear lung sounds bilaterally, normal effort, costoabdominal pattern, no nasal dischargeGIT: soft and pliable, no obvious pain/discomfort even on firm palpation, no abdominal distensionU/G: no abnormalities detectedNeuro: mentation appropriate, full exam not performedM/S: weight bearing left hindlimb lame, reduced range of motion on both hind limbs, mild crepitus on manipulation of joint, no obvious neck or spinal pain, no obvious cranial draw but difficult to fully assess as quite stiffOphth: clear, no ocular discharge or other abnormalitiesInteg: normal coat, no dermatopathyLNs: no peripheral lymphadenopathyASSESSMENT:- cardiovacsularly stable- left hindlimb weight bearing lameness - ddx soft tissue injury vs exacerbation of arthritis vs cruciate rupture vs fracture vs otherOptions offered to client:1) Admission to hospital for musculoskeletal x-rays2) Outpatient pain relief trial and x-rays if no improvement Owner opted for option 2TREATMENT:  - meloxicam @ 0.1 mg/kg PO q24- advised can increase gabapentin to 600mg BID- advised can continued paracetamol however recommend recheck liver parameters if intending to use long term- advised strict rest for neck 4-5 daysPLAN:- trial on pain relief medication- owner to book x-ray appointment with GP service end of week --> cancel appointment if improving on pain relief and rest, otherwise maintain appointment for x-rays if no improvementCLIENT COMMUNICATION:Discussed the differential diagnoses for Maddy's lameness. Outlined the two main options of immediate imaging versus a trial of medical management. The owner elected for the latter. Discussed the plan to book a follow-up appointment with their regular vet for later in the week for reassessment and potential radiographs under sedation if needed. Advised that an appointment through their GP would be more cost-effective than through the emergency service.Advised on medication changes. The current dose of paracetamol is at the higher end of the safe range, and long-term use can carry risks for the liver; recommended discussing blood work with their regular vet to monitor liver function if its use is to be continued long-term. Advised increasing the Gabapentin dose to 600mg BID as the previous 300mg dose was likely sub-therapeutic. A non-steroidal anti-inflammatory (Meloxicam) was added to the treatment plan. Advised to seek further veterinary care if she deteriorates.    Vital Signs    Weight: 44;       HeartRate: 132;