C10018410 / invoice 10000

Appointment Reason: NQR, Appointment Notes: not herself for a week cm10 days more reluctant with foodLess energy on walks, less spark - hard to tell what's arthritis and what's unwell but was walking a little sideways going up a hill Intermittent diarrhoea, normal motion then sloppy 1 hour laterNo vomiting, a little bit of coughing and gaggingDrinking quite a bit, always hasSRR up to 30 few weeks back but 24 then other day and 22 todayNo medication except 4 -cyteDigesticare probiotic from time to timeDiet: Eukanuba dry senior and My dog sachets 7 +Chicken and rice in effort to get her eatingBlood work 9 month ago excellentShort hind limb strideEars cleanEyes: right some scleral injection, clients have noticed mild serous discharge, no blepharospasmTeeth grade 2NAD opening mouthMM pink, CRT 1 secNAD peripheral LNsNo neck pain on manipulationHR 116, murmur 3/6Normal BV soundsRR 40 in clinic during exam but anxious, has been OK today at homeNAD abdomen - can palpate spleen but doesn't palpate as though massCaudal dorso abdominal palpation/ventral hips - turns T = 39.3Spinal palpation OK except LS palpation anxiousStifles OKResists hip extension, turns on LHSAssessment: Right eye, mild irritation - monitorHeart murmur - echo 18 months ago with HP - need follow upInappetent and intermittent sloppy motions - DDx dietary intolerance (has a Hx), infection, neoplasia, metabolic...Hip pain+/- LS painPlan:Declined bloods at presentTry dietary manipulation - keen to try RC GIT cans as not wanting kibble at presentConsider repeat echo and abdominal ultrasound at this time with HP (he did first echo)Pain relief for hips - start course cartrophen, give 250mg panadol BID for 1st week. Avoiding NSAIDs due to to GIT signs, most likely arthritic pain so not gabapentin at this time. Not launching into Beransa when potentially unwell.2nd and 3rd cartrophen with nurse unless not doing well.    Vital Signs    Weight: 21.6;       Temperature: 39.3;       HeartRate: 116;