C10013594 / invoice 10000

Appointment Notes: C5 and GHC as getting older.**HISTORYAny health concerns (Doing really well. Struggling to jump into the back of cars - hesitates now.Fine with jumping out - HLs suspected.When he gets up, hobbling on HLsHas some lumps under both FLs - fatty.  Previously assessed as lipomas.  Are getting biggerIn the last 6 months - getting bald patches on FLs.)Any behaviour concerns (None)Current diet (Unchanged )Appetite and thirst (Normal)Vomiting or diarrhoea (None) Current medications ( None) Worming, flea and tick prevention (Nexgard and worming UTD.  Due C5 and SR12 ) **TRIAGE/TPRMM: (pink, moist, CRT <2 seconds)HR: (88 )RR: (28 )Temp: (38.4 )Demeanor (BAR though nervous and can be snappy.  Not muzzled though better with nurse helper.)**FULL PHYSICAL EXAMEyes (Visual, normal eyelids, no abnormal inflammation or discharge, normal ophthalmic exam)Ears (Minimal debris, no abnormal inflammation, odours)Lymph Nodes (peripheral nodes palpate normally)Oral (no oral lesions or abnormalities detected)Teeth (normal occlusion, grade (C2G1 ), Moderate tartar, mild gingivitis.)COHAT Level Estimated: (B, C)Cardiovascular (Normal heart sounds, no murmurs or arrhythmias detected, femoral pulses synchronous and normodynamic)Respiratory:Nose: (No abnormal lesions or discharge)Lungs: (Lung sounds clear bilaterally, no stertor or stridor detected, no cough observed)Abdomen (Tense though comfortable on palpation, no focal pain, mass effect or organomegaly detected, bladder unremarkable on palpation)Rectal (n/a )Locomotor(Ambulates normally)No lameness or gait abnormality observedFLs - Slight decreased ROM on flexion of both carpals though non painfulHLs - Decreased ROM on both hips on extension - approx 60-65%Spine - No pain on palpation of C/T/TL/L/LS spine)Skin (coat is soft and clean, no ectoparasites detected - Lipomas in axillas:  R>L.  RHS about 50 cent pieces sized. - Hairless lesions discussed are callouses on the elbows.  R>L.Neurological (Normal mentation, no ataxia or CP deficits observed, CN exam normal)Reproductive (External genitalia appears normal, desexed)**ASSESSMENT/DDX(Grade 2 dental diseaseDJD carpals and Hips.Lumps - lipomas - small. )**CLIENT COMMUNICATION(Discussed above findings. - Re DJD - recommended my arthritis management plan. Discussed benefits and expectations of this. Given estimate = accepted.  Given estimate for Xrays of the hips under GA to assess degree of DJD - Re callouses on elbow - bath in diluted iodine BID and can use pawpaw ointment as needed - Re teeth - recommended COHAT and given handout. )**MEDICATION/VACCINATIONS/SR12(Protech C4 SC - batch # 5257038B, exp 27/01/2027Protech BS oral - batch # 5245060A, exp 14/04/2027Afilaria SR12 1.6mls SC - batch # 412588, 06/27Zydax 0.95mls SC )**PLAN(Boost C5 and SR12 in 12 monthsRepeat Zydax in 1 week. ) Handouts given: Health report / Dental -COHAT Estimate provided (GA + Xrays estimate given.  COHAT add on.)Verified: NOHISTORYPresenting for: Jimmy, a 10-year-old male dog, presented for routine vaccination and health check. Owner reports hesitancy jumping into SUVs, hobbling on hind legs when getting off the ground, bilateral symmetrical bald patches on front legs developing over the last 6 months, and existing lipomas under both front legs.Historical Conditions:- Bulging eye episode last year whilst owners were travelling to Europe - foreign body (insect carcass) removed from conjunctival area after 3 days of antibiotics and anti-inflammatories- Bilateral lipomas under front legs previously assessed by previous vet, reported as normal but increasing in sizeCurrent Meds:- NexGard for flea and tick prevention- Heartworm vaccination (due for injection today)- One sardine nightly as treatLifestyle Risk Factors:- Lives with neighbours' 2 dogs that frequently visit and play togetherOther:- Not showing general signs of slowing down, still very active with other dogs- Jumping out of vehicles is no problem, only jumping in- Owner sometimes lifts hindquarters or entire dog into vehicleEXAMWt: 31.3 kgBehavioural: Generally well-behaved during examination. Responds well to head patting for distraction during procedures. Some anxiety during rectal temperature taking due to vulnerability concerns at his age.Oral: Dental disease present with tartar and gingivitis notedIntegumentary: Bilateral lipomas palpated under front legs, larger on one side extending into axillary region. Bilateral calluses on elbows with evidence of licking behaviour.Musculoskeletal: Decreased range of motion in hips on extension, approximately 60-65% ROM. Back palpation comfortable with no spinal discomfort noted.ASSESSMENTOsteoarthritis - early stage affecting hips with decreased ROM and clinical signs of difficulty jumping upDental disease - tartar and gingivitis requiring professional cleaningBilateral elbow calluses - secondary to increased weight bearing on front limbs due to hip discomfortBilateral lipomas - stable, not currently concerning for size or interference with mobilityPLANVaccinations:- Annual vaccination administered- Heartworm injection administeredNew Meds/Tx:- Zydax injections (pentosan polyphospate) weekly for 4 weeks to increase joint fluid and repair cartilage damage ($55.50 per injection)- 4Cyte joint supplement containing glucosamine, chondroitin and Epiitalis (natural anti-inflammatory) - double dose for first 4 weeks then maintenance dose ($95.40)Additional Discussion:- Arthritis management plan focuses on addressing underlying joint issues rather than masking pain with analgesics- After initial 4-week course, Zydax injections will continue monthly with health checks every 6 months- Annual pre-winter course of 4 Zydax injections recommended for ongoing management- Calluses should improve with addressing hip issues. Betadine bathing morning and night recommended if licking persists- Dental procedure estimate provided ($895 set price for 30-40kg dog including anaesthetic, cleaning, polish, X-rays and nursing support)- Hip X-rays discussed as potential diagnostic optionClient Comms:- Weekly recheck appointments scheduled for next 3 weeks for Zydax injections- Estimates provided for both arthritis management plan - Gradual reduction diet to assist with weight management- Monitor response to treatment over 4-week period before transitioning to monthly maintenance protocol    Vital Signs    Weight: 31.3;       MMColour: Pink;       RespirationRate: 28;       HeartRate: 88;       HeadEyes: Normal;       Nose: Normal;       Skin: Abnormal (Lipomas axilla bilaterally);       MusculoSkeletal: Abnormal (DJD hips and carpals.);       Ears: Normal;       Neck: Normal;       LymphNodes: Normal;       Heart: Normal;       Lungs: Normal;       Abdomen: Normal;       RectalGenetalia: Normal;       Demeanour: BAR;       Hydration: Normal;       Gingivitis: 1;       Calculus: 2;       Observation: Abnormal (Moderate tartar, mild gingivitis.);       Temperature: 38.4;       BodyScore: 7;       DentalGrade: 2;       PainScore: 1;       CRT: Less than 1;