C10018574 / invoice 10000

Reason: Sore Neck Referral From CnahAppointment Notes: kngReferring vet communications: Crows Nest & owner emailedDear Crows Nest colleagues,cc Lisa HuntReferral update for Giorgio Hunt, a 5yo MN Staffordshire bull terrier with choroid plexus papilloma and recent neck pain following a fall.History:Diagnosed with papillary choroid plexus tumour at right 4th ventricular lateral aperture in 2023 by RKC, was referred for irradiation to ONE cancer. At the time there were no proprioceptive positioning abnormalities however, there was paradoxic left head tilt & ataxia. Irradiation lead to resolution of all neurological signs & initial post irradiation MRI showed a reduction in tumour mass. The most recent MRI in Nov 2025 showed regrowth of the tumour however, Giorgio remained asymptomatic.Was seen by OOH on 7/3 as went off his food and had suspected neck pain. Had seen rDVM 3/3/2026 for a sore back as had slipped into swimming pool at home 1 week prior, seemed painful after with sudden, significant alteration in posture & gait. Managed symptomatically with 0.1mg/kg Meloxicam PO q24h x 3d for suspected muscle pain however,  have only managed 1 dose as he wasn't eating well enough. Gabapentin & paracetamol seemed to offer some benefit however, no real improvement until oral buprenorphine added to treatment protocol. OOH here noted low head carriage, ambulatory but, almost crawling along the floor, with neck pain. Owner reported short painfulsqueak when moving suddenly or, when owner sometimes approached.Ambulation significantly improved just before preesentation today however, still reverts to slinking gait with lowered head.Subjective:BAR, slinking gait as previously mentioned but, on carpet the gait improves markedly, particularly as he speeds up. In good body condition.Objective:MM pink, CRT 1 secEupnoeic, lung sounds normalHeart sounds normalShort squeak of pain when head elevated - consistent findingResents rotation of head to left, less so to rightNo pain on palpation of low cervical region, nor C1-2No pain on palpation of lumbar spineNeurological examination: Cranial nerves normalNo left head tiltPostural reactions:Absent proprioceptive positioning (0) left forelimbNormal       "                      "          (2+) right forelimbImpaired to absent proprioceptive positioning (0-1+) both hindlimbs, Hopping to left & right normal (2+)Hemiwalk to left and right impaired (0-1+)Reflexes:Flexor withdrawal reflexes normal (2+)  both hindlimbsPatellar reflexes exaggerated (3-4+) both hindlimbsAnal sphincter tone & perineal sensation normalAssessment:Significant proprioceptive positioning deficits have developed, particularly left forelimbAbsence of flexor withdrawal deficits in the left forelimb make a low left cervical lesion unlikely. Left sided proprioceptive abnormalities & neck pain could be due to either a high cervical disc (compatible with trauma history from fall into pool) or recrudescence of choroid plexus papilloma with neck pain from intracranial neoplasia. The development of left long tract signs with a right caudal fossa mass would not be expectedPlan:Paracetol 250mg PO q8hGabapentin 200mg PO q8hBuprenorphone 400mcg PO q12h for 3 days RKC will confer with DL, my recommendation is for repeat MRI unless he improves markedly over the next 48hBest wishes,    Vital Signs    Weight: 16.9;       

Reason: screaming In n Pain, Cant Administer MeloxicamAppointment Notes: as not eatingONE cancer care patiento aware of feeHistory: Brain tumor near brain stem. ONE Cancer Radiation.Most recent scan early March shows slight tumor growth according to Lisa, though overall it remains smaller than original.Chronic skin dieaseLast week he fell in the pool, after getting out he appeared to walk gingerly and slow.He stopped jumping onto furnitureHas trouble with stairsNo longer sat up like a kangaroo ( which he normally likes to do) Was examined at ref vet who found HL pain.Commenced meloxicam, has only has one dose as he is not eating well enough.Examined here same day as he started panting, No pain detected, owner declined work up.Yesterday his walking deteriorated, he would only take a few steps, then sit. Random yelping out , sometimes when he moves, sometimes when owner approaches him, anticiptation.Passed normal stool yesterday.No vomiting.Not eating much past 5 days, he is fussy at the best of times.Not drinking yesterday so owner syringed water.Examine: Mentation anxiousGait normal for breed ( bandy HLs), normal strength.Neck pain present on ventroflexion.CPs normalNo other spinal pain detectedHR 100 No murmur detected PR 100 strong femoral pulsesRR 20 RE normal Normal Bronchovesicular soundsT38.5CDry coat with circular mild crusty skin lesions throughout, chronicPLNs wnlsSkin turgor normalMM pink moist CRT 1secRectal - formed stoolAbdomen comfortablePalpation limbs, joints comfortableTreatment: Methadone 0.2mg/kg SC rump area(NOTE: owner prefers injections to be administered in rump area to stay away from the brain tumor) Assessment: Neck pain on retroflexion, neurologically normal.May have been triggered by a fall near the swimming pool last week.The fall was not observed and could have involved him hitting his head.Keeping in mind that there is the potential for her to develop intra-cranial pain from  tumor though consider this less likely atm as her mentation is normal.Plan: STRICT REST.Raise food bowls. Gabapentin 100mg PO q8-12hParacetamol 250mng PO q8-12hRecheck early next week, or sooner if concerned. May require advanced imaging if nil improvement. Client Discussions: Consult with Lisa and partner. Discussed STRICT rest, recheck if noticing weakness or scuffing of feet. RC early next week to assess response to pain relief.Rc if not eating.Discharge Instructions: Dear Lisa, Paracetamol 500mg : Give 1/2 tablet every 8 hours by mouth for 5-7 days.Gabapentin 100mg: Give 1 caspule every 12 hours by mouth.STRICT REST for 4 weeks.No running, jumping or going on walks.Try offering the breast of a BBQ chicken to tempt his appetite, no skin. Seek a recheck if you notice any stumbling or weakness.Please schedule a recheck appointment at your vet in 3-4 days, or sooner if you have any new concerns, Kind regardsDr Claire BowlandGraduate Diploma of Emergency and Critical Care.    Vital Signs    

Reason: Breathing IssuesAppointment Notes: aware of fee. aprilHistory: Presents for heavy panting this evening. Fell after swimming a week ago with legs splayed. Today went to rDVM who noticed discomfort in right inner thigh. Meloxicam dispensed. 30 minutes post administration, owners noticed heavy panting and were concerned. Otherwise has been well- eating same amount, no vomiting, no diarrhoea, no coughing or sneezing. ONE patient for brain tumour- undergoing radiation therapyExamine: BARMM pink moist CRT<2sHR 130Heart no murmur or arrhythmiaPantingRE normal. No abdominal effort notedNo increase in lung sounds notedAbdomen soft and comfortableNo pain on joint and spinal palpationCN exam normalRest of neuro exam normalAssessment: Distress- possibly due to pain vs GI discomfort from meloxicamClient Discussions: Offered further work up including radiographs and bloods. DeclinedDeclined buprenorphine as well. Prefer to monitor at home    Vital Signs