C10018613 / invoice 10000

Reason: Woken Up And Unable To WalkAppointment Notes: also disorientated, nqr TB O not sure if its cruciate ligament or something else.Attendees:female oHistory:Carried out to toilet this morningNot well since yesterdayNot wanted to eat or drink this morning but was eating and drinking yesterdayNot utd on ftwNo vomiting/retchingNo coughing, no exercise intolerance, no breathing difficultyO thought might be sore in the back L leg where surgery was as abnormal HL movementNo itching and scratchingBright Alert ResponsiveBody condition score 6Examination:Mucous membranes – pink moist crt <2s, hypersalivatingOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade 3Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – no discharge, no erythema, pinna fineLymph nodes - normalHeart – normal regular rhythm no pulse deficits, no murmur HR wnlLungs – clear sounds bilaterally, no crackles or wheeze, tracheal pinch negativeAbdomen – comfortable on palpation, bladder normal, no masses palpated, softer faeces on rectal probeNo gall bladder changes on regional Scan Limbs – normal rom and nonpain on Hl exam, mild crepitis in L stifleNeck and spine – pain in neck flexion and extension and thoracic spinal palpationNormal nerve exam- no deficits in limbsSkin – erythema underside of front paws slightly painful to touchNails – fineAnal glands – not scootingTemperature – H normalGenital region - no masses or swellingsTick search negativeLaboratory:CBC - Retic 113.9, PLT 637, PDW 8.6, PCT 0.65CHEM - ALKP 1166CRP 2.9 - WNLAssessment:Spinal and neck pain- no CRP or white cell elevation- ddx soft tissue injury, IVDD, open- pain responded to 0.2mg/kg IM methadone- tail wagging and no further pain with repeat exam. Advised strict rest and pain relief- given softer faeces on probe have withheld NSAIDs todayDrooling- continued despite pain relief- have covered with antinauseaPododermatitis- advised to recheck spinal pain in 1 week (or sooner if worsening) and devise plan for paws at this time (medicated washes +/- anti itch therapy)ALKP elevation- suspect secondary to dental disease as GB appears ok on US- advised dental in future and can consider scan of adrenal glands if not improvingTreatment:Methadone 0.2mg/kg IMGabapentin 100mg oralPlan: FUC tomorrowRecheck spinal pain and paws in 1 week- sooner if deterioratesNurse notes: KaraAdmit TPR 1000Temp 39HR 140 RR panting PM<2Anxious ++ & painful Blood collected from R jug for inhouse PAS LYTES CRP Methadone 0.2mg/kg IM LHS lumber muscle @1045    Vital Signs    Weight: 8.9;       MMColour: Pink;       RespirationRate: 33;       HeartRate: 112;       Temperature: 39;       BodyScore: 6;       DentalGrade: 3;       PainScore: 3;       CRT: < 1 sec;