C10025354 / invoice 10000

Reason: Hind Limb PainAppointment Notes: Overdue remindersDraw syringe to 17 kg and give ORALLY ONCE (1) a day. Give with food.Discontinue use and call a vet immediately if there is any vomiting, diarrhoea or dark faeces.History:- Presented for acute onset severe left hindlimb lameness. Owner returned home at 9 PM yesterday (12/03/2026) to find Bella non-weight bearing on the left hindlimb. She was normal when owner left at 7 PM.- No known trauma, but may have occurred in the backyard.- Owner initially suspected a paw/digit injury, reporting a soft area under the "finger".- A similar, less severe episode occurred previously which resolved within half a day and was thought to be muscular.- Owner reports multiple skin lumps, which were biopsied as benign a few months ago. One lump is reportedly increasing in size.- Lameness did not improve at home prior to presentation.Specific History Questions:- Vomiting: Nil v+/r+- Mentation/Behaviour: Uncomfortable but BAR.- Defecation: Nil d+- Urination: U+ wnl- Diet & Appetite: Ate this morning. Diet consists of dry food once daily and chicken treats. Last ate this morning.- Drinking: Drinking normally- Environment: Indoor/outdoor with access to a backyard.Current meds:nilProphylaxis:unknownPre-existing conditions:- History of multiple benign skin lumps.- Previous transient hindlimb lameness, resolved spontaneously.Subjective:Mentation: BARObjective:Temp: MM: CRT: HR: = normal quality RR:BCS: Overweight Wt: kgPain score: 0/4CV: no audible arrhythmia/murmurRESP: clear lung sounds bilaterally, respiratory effort normal, no nasal dischargeGIT: abdomen soft and comfortable on palpationU/G: no abnormal dischargeNEURO: BAR, full exam not performed.MSK: Ambulatory x4 but with marked right hindlimb lameness. Significant pain suspected on stifle and hip manipulation bilaterally. Right stifle: Grade 3-4/4 medial patella luxation (MPL), patella sits permanently luxated. Positive cranial drawer sign suspected, but difficult to assess due to discomfort. Left stifle: Grade 2/4 MPL, patella luxates on flexion and reduces spontaneously. Audible click on flexion/extension. Pain on hip extension bilaterally, but may be secondary to stifle pain.INTEG: Multiple subcutaneous lumps noted. No significant findings on paws after clipping and cleaning.OPHTH: Clear tear film bilat. Pupils symmetrical and adequate in size.LN: No peripheral LN enlargement on palpationProblem List:- Acute on chronic bilateral hindlimb lameness, worse on right- Bilateral medial patella luxation (right Grade 3-4, left Grade 2)- Suspected right cranial cruciate ligament rupture- Bilateral hip pain/dysplasia- Multiple subcutaneous masses- OverweightAssessment:Bella's acute lameness is likely due to instability and pain from her chronic bilateral medial patella luxations, potentially complicated by an acute cranial cruciate ligament injury in the right stifle. The right MPL is severe (Grade 3-4), with the patella permanently luxated. The left MPL is less severe (Grade 2). She is exhibiting significant pain in both stifles and hips. Her overweight condition is a significant contributing factor to her orthopaedic disease.DDx:- Cranial cruciate ligament disease (rupture/tear)- Medial patella luxation- Hip dysplasia/osteoarthritis- Soft tissue injury (sprain/strain)- Fracture- Insect bite/sting (less likely)Options Offered to Client for Ongoing Care:- Surgical management vs. medical management.- Referral to a specialist surgeon for assessment and potential surgery.- Diagnostics including examination under sedation and radiographs.- Medical management with strict rest and anti-inflammatory/pain relief medication.Plan:Therapeutic plan:- Strict rest at home, crate rest if necessary to prevent running/jumping.- Anti-inflammatory and pain relief medication to be dispensed for comfort.Discharge plan:- Dispense pain relief medication.- Booked for a surgical consultation on Thursday 19/03/2026 at 9:00 AM.- Owner to monitor for worsening lameness, inappetence, or other signs of pain.Referral plan:- Surgical consult scheduled for 19/03/2026.Client Communication:Discussed findings of severe bilateral medial patella luxation, worse on the right (Grade 3-4), and suspected concurrent cranial cruciate ligament rupture. Explained that the patella on the right knee is permanently out of place. The left knee also has an unstable patella (Grade 2). Explained that orthopaedic surgery, likely by a specialist, is required for the right knee and eventually the left. Discussed that surgery is not an emergency for today but should be addressed soon to prevent further deterioration and reduce pain, particularly as she will put more strain on the already compromised left leg. Advised on strict rest and crate confinement at home. Provided a cost estimate of $6,000-$7,000 per knee for surgery. Discussed risks associated with sedation/anaesthesia. Owner confirmed pet insurance is in place. Confirmed with a specialist surgeon during the consult that surgery is indicated. Owner agreed to proceed with a surgical consultation and an appointment has been scheduled for Thursday, 19/03/2026 at 9:00 AM. A summary of findings will be provided to the owner.Your pet has presented with lameness. There are many causes of lameness in dogs and cats including soft tissue injuries, joint and ligament injuries, dislocations and fractures. Sometimes xrays and other tests are needed to determine the cause of the lameness.  If there is a worsening, or no improvement, in your pet’s lameness within 2-3 days please discuss these tests with your regular vet or the AEC.Please follow these important guidelines to prevent your pet’s condition become worse: Strict ‘cage rest’----this means your pet must remain in a crate or playpen at all times. If this is not available, a small room (eg toilet or laundry) may suffice. ----On-leash walks outside to the toilet only----NO running or jumping----NO climbing on or off furniture----NO going up or down stairs ----NO playing with other pets or childrenAlthough these guidelines seem strict, and your dog may not enjoy being rested, it is in their best interests and further activity is likely to worsen the problem.Your pet has also been prescribed anti-inflammatory medications to provide some temporary pain relief.----Please give these medications according to the label instructions and on a FULL STOMACH----If your pet goes off their food, has any vomiting or diarrhoea then please stop the anti-inflammatory medications and consult your regular veterinarian for advice---- Please note that although your pet may be much improved after taking the medication, it can mask their pain and encourage them to be more active. Excessive activity may worsen the problem, so strict rest must continue to be enforced even if they seem much better. If you have any concerns about your pet’s progress in the meantime, please contact your regular veterinarian or the AEC.    Vital Signs