C10023847 / invoice 10000

Reason: RV Limp ASGAP ONLY HISTORYFirst clinical signs - limping for past week or so. Also chronic vomiting discussionSummary - limping for past week or so. Also chronic vomiting discussionDiagnosis - possible IBD - vomiting? Open diagnosis for now. And limping - unknown origing ( RFL). Treatment - rest trial and recommend xrays if problem persists. Diet trial - hills food & consider repeat U/S if vomiting continues & consider referral to specialists.increased v+ at least 3 -4 times a week, slowly increasing over the years just want to make sure it's okay, apart from limp and v he is still his crazy kitty self ASVerified: NoSubjective:Diet: Hills prescription dietRecent changes to diet: Trying different Hills foods, previously tried various foods to address vomitingPreventative healthcare:Vacc: Vaccinated in July 2025HWP: IW: Flea/tick: HISTORY:O's presenting complaint/s: Right front limb lameness intermittent over past week, chronic vomiting episodes- Pronounced limp on Saturday, improved Wednesday-Thursday, worsened again today- Lameness more noticeable when walking faster and after periods of rest- Still jumping up and down normally, terrorizing sister cat- Chronic vomiting - not daily but can be BID weekly, sometimes goes 1.5 weeks without vomiting- Had severe vomiting episode on Sunday after pain medication administration- Previous ultrasound in August 2025 showed small intestinal wall thickening suggestive of IBD- Owner away since Sunday, returned today when lameness became more apparentAppetite: NormalThirst: NormalVomiting: Intermittent - can go 1.5 weeks without episodes, then may vomit BID for a week, severe episode on SundayDiarrhoea: Nil - neither cat has had diarrhoea for a long timeAccess to chemicals or toxins: Nil knownAccess to rodenticides: Nil knownCurrent medications: Pain medication given Saturday (stopped due to vomiting reaction)Previous medical history: August 2025 - ultrasound revealed small intestinal wall thickening with irregular layer ratios, blood work unremarkable (liver and kidneys normal), also had eating difficulties and toileting issues at that timeExamine:PHYSICAL EXAMINATION:Mentation: alert and responsiveEYES: NAD - clear, no noted dischargeEARS: NAD - clear, no discharge, odour, erythemaNOSE: NAD - clear, no discharge, symmetrical, no lesionsORAL: NAD - normal pink and moist mm, normal CRT, healthy teeth & gumsCARDIOVASCULAR - NAD - no murmur or arrhythmia auscultated, pulse pressures normal and synchronousRESPIRATORY: NAD - thoracic auscultation clear sounds bilaterally, respiratory effort normalABDOMINAL: NAD - soft pliable, no detectable pain or palpable abnormalitiesNEURO: NAD - neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMUSCULOSKELETAL: Mild right front limb lameness observed on examination, normal ROM in all joints from shoulder to digits, no focal pain on palpation of joints or nailsRECTAL: not performedREPRODUCTIVE: externally normalINTEGUMENT: NAD - clear coat and skinLYMPH NODES: NAD - peripheral nodes palpate normalAssessment:Problem List:- Right front limb lameness - mild, intermittent, possibly arthritic or soft tissue strain- Chronic intermittent vomiting with previous ultrasound findings of intestinal wall thickening suggestive of IBD- Differential diagnoses for lameness include arthritis, soft tissue strain, behavioural component- IBD suspected based on previous ultrasound findings and chronic vomiting patternLaboratory:Treatment:Plan:- Monitor lameness for 1-2 weeks, avoid excessive attention to limping behaviour- Consider radiographs if lameness persists or worsens- Solensia injection reserved for cases with daily lameness affecting mobility- Dietary trial with different Hills prescription diets for IBD management- Minimum 6-8 weeks trial per diet, may need to try 3 different foods- Keep vomiting diary to track frequency and patterns- Repeat ultrasound in 6-12 months if vomiting frequency increases despite dietary management- Consider referral to cat specialist for GI biopsy if conservative management fails- Monitor for changes in jumping behaviour and mobility patterns    Vital Signs