C10023314 / invoice 10000

Reason: Recheck Not ImprovingAppointment Notes: LAWHistory:Clinical signs/progression: Monday went to park - eating fine - poo was weird last week- lots of mucus Tuesday was off- but ate wet food - not right though Wednesday refused food - came to see us, ddx open - painful?Shaking legs 7 months - needs massage to settle it down...  Sometimes get carried home Drinking? No, not drinking at home, owner has been syringing water Chicken does upset his tummy- ate 3 small pieces - been offering that as usually loves it Wanted to walk this am- - then wanted to come home - tail has been down. Gets anal gland expressed often, was told empty yesterday- will check again today Owner concerned may have swallowed some duck tendons... Also comment has a sore near anus- bleeding?Sig hx: rescue dog, was abused when younger. Current meds: was not able to give pain relief as he hasn't eaten. Temgesic given last night Appetite & diet: kiwi diet and farmers market- very fussy in general Prev Care UTD/products?: not discussedObjective:Vital signs recorded to LEFT columnTemperament: QAR, says generally quiet... Ophtho: NAD Otic: NADOral: owner lifted lip for me, mm pink crt<2secsNose: CV, pulses:  60 heart rate - lower than yesterday- checked twice, second time 70--- significance? Resp/Chest:  clearU/G: desexedAbdo palp: tense but nothing obvious palpated and no active pain response. Neuro: normal Musculoskel: cannot locate obvious back pain however does walk hunched and tail is down Integ: ok Hydration: Other findings: temp normal Problem list: not eating Has had mucus in poo Doesnt want to go for walks Assessment: pain? Not eating something happening in abdomen? Other? DDX is open... Plan: Discussed admit for IVF - xrays (discussed limitations) and more pain relief- send home tonight, INI then SASH for CT scan. Owner consents. Bloods yesterday-were good!IV catheter placed around 2pm. Started on maintenance IVF PCV 57 TP 70 Prevomax given IV 0.7ml Temgesic 0.2ml given IV Await xrays results before giving more meds. Xrays- nothing obvious for concerns of FB, question small area- spleen? But not convinced. Had prokolin and clavulox at 4pmTook out to walk at 5:40 and seemed brighter, happier- does tend to hyperextend hock right hind and does shake on this leg Proprioception all ok - no back pain Tense in abodmen but nothing obvious Refusing to eat chicken but does sniff it... Temgesic given IV at 4pm Still hard to work out where pain is coming from Client Comms: +/- Prognosis, tx declinations+/- record conditions/meds in ALLERGIES tabDelete prompts as necessaryRadiology Report* Full report available via Keystone Omni within 5 days of study creation* Key Interpretations/Findings:* Ddx: * Further studies recommended?PLAN:Try to feed tonight, see if he eats, if so give nsaids (and monitor poo)Continue on clav and also prokolin tomorrow morning STRICT rest INI then go to SASH for work up - asked nurse to do online referral.    Vital Signs    Temperature: 38.12;       Weight: 6.9;       HeartRate: 60;       

Courtesy Call: Didn't have any pain relief as he isnt eatingHad to syringe 20mls of water into himStill not eatingWalking around but has tail between his legs and looks miserableFollowing mum aroundHis poo has a lot of mucous so O can't do chicken. Has digestive issues so not a lot of yummy foods we can haveO said he seems like he is in pain - I said yes really need to get him to eat so we can give him pain relief. Will keep in touch with O throughout the day to see if there is any improvement/if he is eating/managed to get pain relief inIf not I have tentatively booked 4pm vet consult to see if we can give another type of pain reliefLAWSpoke to JSP - called O back to see if she could come earlier. Atm she can't but will call me if she can (has tradies at her house)Confirmed 4pm for nowHe has just done a poo but his bottom was so close to the ground and O thinks there is a little bit of bloods. LAW    Vital Signs    

Reason: Flat, LethargicHistory:Clinical signs/progression:MOnday was fineHad moments when off and on for a while but in general is fineYesterday when went to get him up, let out a shriek (never does this)Went for his toilet walk then came home and stayed same spot all dayUsually palyuful, play soccer etc, greets owners with toy, yesterday couldnt even get off sofaHad a tin applause topper- is a fussy eater in general, ate when he had toDrank a little bitThis morning again yelped, didnt want to get up Feel like hurt back or pawMon- stepped on acorn and limping for a shott time then fineMaking owner carry him  last 2 days Lately been getting up to drink over night Gets a massage everynight in generalLast year vomited 8 times after vaccinationHas a skin thing- puppyfarm dogWas on anti anxiety medsSig hx: nilCurrent meds: Appetite & diet: Prev Care UTD/products?: Objective:Vital signs recorded to LEFT columnTemperament: nervousOk until pushed then scramblingOphtho: nadOtic: nadOral: missing most upper teeth, has lower molars minimal diseaseNose: nadCV, pulses: no murmur or arrythmia, no as crisp but no obvious murmurResp/Chest:  nadU/G: nad has glands checked monthly at groomerAbdo palp: nad soft non painfulNeuro: normal, proprioceptionMusculoskel: no obvious pain on palpationNeck moving fine Integ: nad ( No Abnormalities Detected)Hydration: normalOther findings: Problem list: Laboratory: Bloods all WNL Assessment: Suspect musculoskeletal painPlan: Tem 0.3ml IM given to facilitate bloodsContinue on meloxicam oral for 7 days with loading dose tonightINI,, worse revisit and owner would do imaging (said full body CT as cant localise pain)Treatment: Progress notes: Client Comms: +/- Prognosis, tx declinations+/- record conditions/meds in ALLERGIES tabDelete prompts as necessary    Vital Signs    MMColour: pink;       Temperature: 38.3;       Weight: 7.1;       HeartRate: 100;       CRT: <1;