C10013218 / invoice 10000

SORE FOOT

HISTORY 
Presented for LFL lameness that started 6 days ago. O thought it was the same leg as last time but checking history that was RFL - resolved without further issue. 

Was doing better the next day, then O went away to Brisbane and left dog with son and mother (suspect the dog would have been left in the backyard to her own devices while gone). Is a chronic fence runner and overall silly BC. Came back from being away and yesterday was much worse, holding the foot up conistently and limping. Locked on veranda and stopped all exercise. No medication given. 

Today hugely better, no limping at all but still opting to lift the paw up 50% of the time at rest. 

Otherwise well. 

PHYSICAL EXAM:
DEMENOUR: BAR 
HR: 110
RR: 40
MM: P, M, <2 
CARDIOVASCULAR- normal rhythm, no murmur or arrhythmia
RESPIRATORY- normal bronchovesicular sounds, no crackles or wheezes
ORAL- GRADE 2/4, no abnormalities
EARS- clean, no odour, discharge or erythema
EYES- clear, bright, symmetrical
ABDOMEN- soft on palpation, no pain or abnormalities noted
LYMPH NODES- NAD
INTEGUMENT- clean, healthy coat
MUSCULOSKELETAL- holding LFL up in consult intermittently, did do lameness exam on ramp but Bella is VERY KEEN to drag herself home so not an accurate assessment. No overt limp. Stands square in consult when using limb. No response to flexion/extension/palpation of shoulder, initially resented flexion of the elbow but not repeatable, no issue with carpus, repeated pain response on palpation of phalanx 2 of digit 3, no response to flexion of the digits. 

OWNER COMMUNICATION 
Given improving lameness with rest, and type of reaction to assessment suspect soft tissue injury over skeletal. Very likely to have trained ligaments in the toe with her excessive twisting/fence running behaviour. 
Not an easy area to rest, need to have strict control over her activity for 4-6 weeks. Once 7 days post initial injury, can start straight line CONTROLLED WALKING for 5 minutes at a time, increasing by 5 minute increments over weeks until back to normal level of activity. Warned sudden return to full activity too soon will likely reinjure the area. 

TREATMENT
Meloxicam 0.1mg/kg PO SID 3 days