C10025850 / invoice 10000

13/03/2026 Hx:
consult notes haven't been written JAMES.

Ralph presents with a 3 day history of shifting lameness. Initially presented for pulling up sore in his forelimbs after exercise, more noticeable in the left than the right. Ralph was initially recommended 7 days of non-steroidals (meloxicam) and exercise rest. This has lameness progressed to his hindlimbs in the last 24 hours. He did not have a noticeable response to the meloxicam, but his owners felt after they gave him a dose of prednisolone of their own he improve marginally.

He is still eating and drinking well, and has had no vomiting or diarrhoea.

Historically, when he was 12 months old, Ralph was treated with prednisolone for presumed IMPA which resolved. He has also had intermittent episodes of forelimb lameness throughout his life which seem to respond well to conservative management with analgesia and exercise rest. He has also been treated for uroliths which resolved with diet modification.

Ralph's only current medication is the previously prescribed meloxicam, the one off 20mg dose of prednisolone dose his owners gave him and sucralfate tablets prescribed to reduce likelihood of gastric ulceration.

Ex:
TPR all normal
Pink mm, CRT <2s
Low head carriage, resents dorsoflexion of the neck.
Ataxia all four limbs. kind of looks like a two engine gait. wide swinging hindlimbs and proppy forelimbs.
No pain on joint manipulation.
reduced stability on wheelbarrowing and hemiwalking
mild CP deficits FL
CRP WNL

Ax:
Suspect cervical lesion, poss spondylomyelopathy given recurrent nature. DDx IVDD, neoplasia.

Px:
Discussed with owner, less concerned about recurrence of IMPA given normal CRP and no joint swelling or pain. Main concern is a cervical spinal lesion. Owner mentioned she has been concerned for years that Ralph has a problem with his neck, as he repeatedly has shown issues with it over the years.
Adv that x-rays and joint taps are likely to be unrewarding in Ralph's case. If we're going to pursue further diagnostics, will get the most information from a CT +- MRI.

Owner would like to pursue referral. Hx sent to GARS and can be admitted via ECC