C10017264 / invoice 10000

Appointment Notes: PH still just not rightReason: Restless, not sleeping well at night, panting more than usualSubjective: EDDU normally, No V+ or d+O reports restlessness, poor sleep at night, increased panting. Video shows base wide hind stance, bunny hopping with hind legs together.Objective: BARM/S: Base wide hind stance observed on video, bunny hopping gait. No pernicular reflex on lumbar spine. Normal ambulation, ability to stand and sit.Assessment: Lumbosacral junction pain/discomfort - significant CT changes at lumbosacral junction consistent with clinical signs and gait abnormalitiesTreatment: Currently on Previcox 227mg 2 tablets PO SIDPlan: - Add Gabapentin 600mg PO BID for next 5 days- If Gabapentin effective, phase out Previcox- If Gabapentin ineffective, discontinue and trial Amantadine 100mg PO BID, this might need to go to 200mg bid - Reassess in 3-4 weeks after initial medication trials- Consider acupuncture and laser therapy- Discuss hydrotherapy options with O but dog probable not a good candidate, hates water - Consider physical rehab- Glucosamine supplementation discussed- Rose hip vital discussed- Heat mats on lumbosacral junction- Weight loss recommended- Regular controlled exercise advised____________________________INSURANCE HXInitial Assessment > Lumbosacral junction pain/discomfortSuspected cause > Degenerative lumbosacral diseaseDate of first clinical signs > last few months Any other conditions / treatments > Currently on Previcox 227mg 2 tablets SID. CT performed showing significant changes at lumbosacral junction.Hi there,Thanks for bringing Sullivan to the clinic today.As a recap, we examined Sullivan for his restlessness, poor sleep, and increased panting. The video you showed us of him running revealed he's bunny hopping with his hind legs and has a wide stance. The CT scan showed significant changes at the lumbosacral junction in his spine, which explains his gait issues and difficulty getting comfortable at night.Sullivan will continue on his current Previcox 27mg, 2 tablets once daily. For the next 5 days, we're adding Gabapentin 600mg twice daily. If the Gabapentin works well, we'll try phasing out the Previcox. If it doesn't help, we'll stop the Gabapentin and try amantadine 100mg twice daily instead.After trialing these medications for 3-4 weeks, we'll discuss acupuncture and laser therapy with Jenna. Physical rehabilitation may also be beneficial for Sullivan.We also discussed several management options including:- Glucosamine and rose hip vital supplements- Using heat mats on the lower back area- Weight loss to reduce pressure on his back- Regular controlled exercisePlease contact us in 3-4 weeks to discuss how Sullivan is responding to the treatment and to arrange the next steps with Jenna.Thanks,    Vital Signs