C10023767 / invoice 50000

Appointment Reason: Recheck , Appointment Notes: recheck ears ccPresented for recheck of lamenessConsistently sore shoulder. O's thought she was dropping down on left shoulder so her right shoulder is the sore one but not sureShe limps in the morning and limps after exercise however she is still able to run at the park and jumpMeds: meloxicam, paroxetine 20mg 1/2 tab (O's struggling to give this, wondering if we have a liquid, hasn't made much difference)ExamMSK - extension of RF no obvious pain response. Extension of LF (shoulder) causes yelpingAssessmentSore shoulder was R shoulder initially and now happening in L. Poss soft tissue from overdoing it, daxie legs resulting in poor load bearing through front legs would compound issue. Adv rads to RO anything more sinister/assess general conformity of FLs/ensure just soft tissue - O's keen for these.TreatmentMeloxicam SID for 14 daysRest! (but O's find this very difficult)Paroxetine 1/2 tab- can increase to full tablet once he has been on 1/2 tab for 2 weeksPlanBook in for rads when suitsAdv taking video of limping when obviousRE: paroxetine, can get compounded but would likely be quite expensive. O's will think about itHas stopped Meloxicam and GI issue has resolved but lameness in the RF has recurred.Booked in tomorrow for sedation and Xray, also check ears, clip nails.Presented for lameness LHArthritis in shoulders diagnosed on radsLimping on LH now. O showed video, hopping lameness that resolves quicklyPrevicox everydayNeeds AGs done, no other concernsExamBARMM pink moistCRT <2sEENO: NADTeeth mod tartar, mild gingivitisThoracic ausc: NADAbdo palp: soft comfortableMSK: L patella mobile and can luxate with force, hip okNeuro: NADUrogenital: NADAGs expressed: full but normal d/cBCS 5/9Nails ok, don't need a trimAssessmentSuspect MPL grade 1 LH causing skipping lameness - conservative management at this stage (daily pain meds, maintain lean BCS)Dental diseaseTreatmentContinue previcoxStrongly advised dental S+P maybe extractions - can do knee rads when under if within O budgetPlanResee as needed for AGsDog is paroxetine as a baseline (liquid compounded)has a young child staying for next few days and marked increase in anxieytno consultsLVW reccomende trazodone 50mg sid-bid, and also zylkenehandout requiredvisit required to future dispense of this