C10025690 / invoice 10000

Spoke to O, Nora has improved so would like to cancel x-rays booked for Monday 16th March WM

HISTORY:
Presented for: limping on LHL
Since tuesday LHL unable to walk properly, initially mildly limping but worsening. 
No known trauma, but is a very excitable dog, likes to run around and jump.
Is otherwise well. EDUD normal. No V/D/C/S.
Had heat 4 weeks ago. No concerns with this.
No current medications.

EXAM:
BAR
mm pink and moist, CRT < 2 seconds
HR 108, no m/a
RR 24, normal effort and pattern, lungs clear
EEN: NAD
LNs: not enlarged
Abdo: soft, comfortable
MSK: LHL - toe-touching lameness, dog sitting position when stationery. very reluctant to extend stifle, quite reactive and painful. patella feels stable, unable to appreciate cranial drawer. allowed full ROM both hips, although stiffer on L hip. other limbs/joints NSF. 
Genitourinary: female entire, vulva NSF, no discharge
T: not taken

ASSESSMENT:
LHL lameness, painful on stifle DDx soft tissue injury (muscle/joint pain, cruciate rupture) vs bone injury (patellar luxation, fracture) vs other

PLAN:
Disc ddx as above. Recommended x-rays of LHL and hip. 
Estimate on file - O expressed cost-constraints and wants to trial pain relief, although still booked for Monday 16/03. Will call to cancel if O feels no longer needed.

TGH meloxicam 25 kg dose sid PO
gabapentin 300 mg bid-tid PO
STRICT rest for at least 2 weeks, or until rads done. 
Booked for rads under GA on 16/03.

COMMUNICATION:
As above

Snice visit. Vomitted once this morning and saw some vomit piles around place.
Diarhoea ongoing. 
no blood noted in vom/diarrhoea.
Still has appetite - eating chicken.
UTD with parasite control 
probiotic finished.

PE;
BAR
Pink MM, <2s CRT - Tacky/dry - no skin tent
HR 104, no murmur detected
RR effort normal, lung fields clear
Abdomen comfortable
LN NAD
T 38.2C

Assessment: Vomiting/diarrhoea - suspect secondary to gastroenteritis vs other - allergy/intoll vs partial FB vs addisons

Treatment:
Continue with pro-kolin 3ml PO BID
Oralade slowly - 20ml/kg
Maropitant 1mg/kg given SQ
Continue with bland diet

If no improvement, we stop eating, continue to vomit, return for diarrhea analysis/pcv, radiographs & blood tests. Offerred today but given how bright Nora is - O declined.