C10027900 / invoice 10000

HL lameness - possible xrays
Will be fasted, O bringing in parent hip scores

lameness on LH repeatable and scuffing toenails?
o reports seems to wax and wane on LH will run around and be fine some days and other limping on it
does not appear to be shifting lameness seems consistently the LH, but seems swobbly on back end sometimes

otherwise well but seems skinny o noticed recently - on exam BCS 4/9 is trim but v leggy GSD.

Clinical Exam
BCS : (4)
(BAR)
MM: (Pink and moist, CRT <2 sec.) 
Temperature:(38.6)
Cardiovascular: HR (120)/min, Pulse (strong and regular), (no murmur) auscultated
Respiratory: Rate  (28)/min, Normal bronchovesicular sounds
Mouth: NAD  dental score (0)/(0). Bite conformation (normal)
Eyes: (NAD, clean and clear, no discharge)
Nose: (NAD, clean, no discharge)
Ears : (NAD, clean, no discharge)
Gastrointestinal: (Soft and comfortable with palpation, no masses palpated)
Genito/Urinary: (NAD). 
Integument: (Coat is clean, no ectoparasites noted)
MSK: (able to ambulate well in consult)
Neurological: (NAD, full exam not performed, BAR)
Lymph Nodes: (NAD)

Assessment:
(checks over well v wriggly, walks okay in consult)
RH okay LH not keen on full hip extension but also on L stifle extension, on exam L stifle medial thickening marked and swelling.
no crepitus/instability no obvious growth plate issues

under sedation more laxity L stifle than right
popliteal LN okay

seemed uncomfortable in frog leg position for x ray DV hips

ddx- panosteitis, hip dysplasia, stifle inflamm, disc disease

Treatment Plan:
NSAID await second opinion ortho input

Next steps: () await report

4 month F German Shepherd presents for limping of the LH. Started yesterday, walking strangely and keeping LH lifted off the ground, starts to bite when Os touch the L hip. Recently had final puppy vaccination, has been running around a lot at home and on walks, very crazy pup. Adopted from breeder - unsure if Os hip scored. Skin has settled down a lot since last appointment, Os unsure how often to shampoo and conditioner, but have noticed an improvement since starting on the shampoo and conditioner. Eddu normal, no CVSD.

Clinical Exam
BCS : (4/9)
(BAR)
MM: (Pink and moist, CRT <2 sec.) 
Temperature:(NT)
Cardiovascular: HR (120)/min, Pulse (strong and regular), (no murmur) auscultated
Respiratory: Rate  (unable to assess - patient playing and moving too much)/min, Normal bronchovesicular sounds
Mouth: NAD  deciduous teeth present
Eyes: (NAD, clean and clear, no discharge)
Nose: (NAD, clean, no discharge)
Ears : (NAD, clean, no discharge)
Gastrointestinal: (Soft and comfortable with palpation, no masses palpated)
Genito/Urinary: (NAD). Able to find a small inguinal hernia, but very small and difficult to examine. No recent growth or enlargement.
Integument: Unable to locate areas of skin scabbing - patient not tolerating examination of the right hip cranial to HL as requires weight bearing or rolling onto left side. 
MSK: painful on extension of the left hip. Allows ROM of the right. Normal proprioception. Normal ROM of both stifles. Painful on palpation of the left hip. 
Neurological: (NAD, full exam not performed, BAR)
Lymph Nodes: (NAD)

Assessment:
LH lameness - grade 2 /4 
Ddx soft tissue injury v HD v other developmental skeletal anomaly

Treatment Plan:
Meloxicam SID 3 days and REST - patient too young for previcox
If no improvement, recommended sedated xrays to assess hips
Work on long term muscular development over the hips to protect them e.g., swimming/hydrotherapy / walking up hill and on sand

3rd vacc

History: doing well this month. EDDU normal with no CVSD. O has noticed that Sunny is nibbling at HLs and dorsum - no lumps or scabs currently. Has had wheepy OS intermittently - no colour or mucus, eye otherwise appears healthy. O has also noticed that Sunny will walk whilst urinating and will splash on her legs causing her to groom. 
UTD with Nexgard spectra q1m. 
Diet: No changes. 

Clinical Exam
BCS : (4/9)
(BAR)
MM: (Pink and moist, CRT <2 sec.) 
Temperature:(38.4)
Cardiovascular: HR (90)/min, Pulse (strong and regular), (no murmur) auscultated
Respiratory: Rate  (20)/min, Normal bronchovesicular sounds
Mouth: NAD  dental score (0)/(0) - deciduous teeth present. Bite conformation (normal)
Eyes: (NAD, clean and clear, no discharge) OS has evidence of tearing in medial canthus but sclera, cornea and conjunctiva NAD. No evidence of entropion or ectopic cilia, no chemosis or hyperaemia. 
Nose: (NAD, clean, no discharge)
Ears : (NAD, clean, no discharge)
Gastrointestinal: (Soft and comfortable with palpation, no masses palpated)
Genito/Urinary: (NAD). - Cannot feel inguinal hernia today. Vulva is recessed.
Integument: (Coat is clean, no ectoparasites noted) - skin appears healthy, no evidence of breaks in skin or erythema
MSK: (able to ambulate well in consult)
Neurological: (NAD, full exam not performed, BAR)
Lymph Nodes: (NAD)

Assessment:
(fit for vaccination)
1) Unilateral epiphora - DDx: ocular irriation (foreign material, allergies, ectopic cilia not observed) v abnormal tear drainage (puncta absence, nasolacrimal ducta stenosis or blockage)
2) Nibbling/chewing - DDx: pruritus (infection [parasites v bacteria] v skin allergies [food v environmental) v behavioural
3) Inguinal hernia - not palpable today. 

Treatment Plan:
(Vaccinated with Nobivac C 5 SQ scruff. Next due FEB 27)
Discussed desexing after first heat, closer to 1yo. 
Discussed allergies with O and explained unfortunately Sunny is too young for a lot of allergy medications. Recommended trialling medicated shampoo to see if provides relief (always follow up with conditioner) and discussed trial of fish oils to help build the skin barrier. 
Briefly discussed food/diet modification as well but less common for food allergy so young.