C10016036 / invoice 20000

Subjective:- Consultation for mobility issues and pain management.- almost 15yo- Reports increased stiffness, particularly in the back legs. - slips on floors, have grip socks that help- can't get up onto couch but can get down- Symptoms worsened after jumping off  couch at Christmas, was unstable for 3-4 days, reluctant to walk, and would fall over. Responded to melox- Unable to jump onto chairs as previously able. Can get on and off the couch but this can cause instability.- not very active, not walk him much.- Owner reports shaking/tremors, which have improved on gaba. Also notes some cognitive decline signs (wandering, disorientation) at night, which have improved with gaba.- No known food allergies or sensitivities.- MEDS: Neulin for coll trach, Gabapentin (one in the morning, two at night, but owner has been giving one at night recently), 4cyte gel, Metacam (as needed), and Wellness powder intermittently as on home cooked diet.- Diet: home-cooked human food (turkey, chicken, beef mince) with some vegetables. Has been fussy with food recently, can be hard to get meds in.Past Medical History:- Left front toe amputation 2-4 years ago due to a stage 2 tumour, type unknown. Hx= G2 STS, clear margins- Neck strain last year, causing pain with movement.- History of loose stools, treated with probiotics.- Cataracts.- Weight has increased from ~7kg to 8kg over the last 4 years. Owner reports difficulty managing weight despite efforts.Objective:- General: Overweight (8kg). Body condition score 7/9, aim 6.6-7kg- Gait: Stiff in all four limbs, reduced lat flexion through tunk. Flat but rigid back, notably wasted HQ mm.- CP: LH mildly slow, rest normal. Cx AROM ok but reduced lateral bending from mid chest- strength <3/5 x4- Spine: Tightness through all epaxials, worst T/L and lower Lx-LS. Rhomboids, traps and lats tight and TOP- Front limbs: Reduced R elbow flexion and bilat stiffness and thickening. Midlly swollen through the R shoulder joint area, stiff and sore to extend. LF leg mild IR/toed in, missing D5. Tightness noted in L antebrach and bilat brachial muscles, particularly the biceps . Scap glides markedly reduced- Back limbs:Bilat mm atrophy. Right hock is effusive and thickened, reduced flexion. Stifles thickened and crepitic bilat. HIP ROM OK. Pelvis is tight, bilat SI jammed. Slow proprioceptive response LH could be weak cf neuroAssessment:- Diagnosis: Multifocal osteoarthritis. Muscular tension and spasm. Overweight/obesity contributing to inflammatory state and joint discomfort. Hindlimb weakness and muscle atrophy.Tx:- STM epaxials, FQ & HQ - mobs and joint pumps x4- elbow traction 20 sec x 2 bilat, G2 cdl GH glides 20sec, G3 cdl tibiotalar glides 30sec RH- scap glides, SI mobs, G2 DV glides Tx and Lx- Ax: GV14, GV-LS, GB21R, LI11L, BL18L, BL20R, BL23L, BL28R, BL60/KID3R- Gabapentin: Increase to one tablet twice daily (morning and night) for consistent pain relief. Can increase to two tablets at night if cognitive signs persist without increasing morning dose. Cont 4cyte- Laser therapy planned for next session to target stiff joints pending toe tumour type (shoulders, back).Plan:- Follow-up appointment in two weeks to reassess comfort level and response to treatment.- Owner to do daily massage and stretching exercises at home (fitpaws sheet given, spine the focus now). Described massage technique for owner to perform at home: 3-5 minutes each area on front legs, back legs, and along the spine.- short, gentle walks (e.g., 5 minutes) as tolerated, building up gradually. Even just walking to the front gate TID.- Discussed potential future options if oral medication becomes difficult, including ketamine injections or CBD oil.- Discussed importance of weight loss for reducing inflammation and slowing arthritic decline. Target weight ~6.8kg.- Advised on dietary management: aim for 20% vegetables for fibre to support gut health. Suggested mashing vegetables into meat to improve palatability.- Discussed hydrotherapy as a future option for strength building with low impact.- Discussed traction socks vs. Dr. Buzby's ToeGrips. Advised ensuring feet are dry before using socks to prevent skin infections.