C10028187 / invoice 10000

Reason: Collapsed, Progressive WeaknessHospital Day: 2ICU DAYTIME SOAP day shiftCase Summary:Jaxon is a nine-year-old male neutered Rottweiler with a history of right hind limb amputation for an osteosarcoma last year, with no evidence of thoracic metastasis on computed tomography at the time. He presented with a six-week history of progressive left hind limb weakness following a fall, which has advanced to involve the forelimbs. He is currently non-ambulatory and presented collapsed. A repeat computed tomography of the chest six weeks ago was clear. He has been deteriorating with reduced appetite and knuckling. He is hospitalised for supportive care pending euthanasia tomorrow.Examination:Subjective:Quiet, alert, and responsive. Recumbent and unable to stand without support. Appetite is poor.Objective:Quiet, alert, and responsive. Muzzled for examination due to potential aggression. Mucous membranes are pink. Capillary refill time was not performed.Temperature: 37.7CVS: Heart rate 80 beats per minute, normal rhythm. Blood pressure 144/87 mmHg, mean arterial pressure 99 mmHg. Extremities are cool.Respiratory: Respiratory rate 32 breaths per minute, normal effort.Abdomen: Comfortable on abdominal palpation. Genito-Urinary: Has not been voluntarily urinating. Requires bladder expression or support to urinate.M/Skeletal: Requires support to stand. Non-ambulatory.Neurological: Reduced withdrawal reflexes in the forelimbs and absent in the hindlimbs. Hypermetric in the forelimbs. Posturing consistent with a sheering lesion.Eyes/Ears: Unremarkable.Integument: Appears well hydrated.LN's: Lymph nodes unremarkable.BWT:[Not recorded]Nutrition:Not eating today.Fluid therapy:Intravenous Lactated Ringer's Solution at a maintenance rate.Laboratory:Blood work and urine analysis were unremarkable. Was dehydrated on admission.Assessment:Tetraparesis, likely secondary to a high cervical spinal lesion as per surgical assessment. Poor prognosis. Osteoarthritis is a possible differential for historical hind limb soreness. The owners have elected for euthanasia due to the poor prognosis and challenges of nursing care.Plan:Continue supportive care overnight.Discontinued fentanyl and ketamine infusions this morning as per surgical team.Continue paracetamol 15 micrograms per kilogram intravenously every 8 hours.Attempt to express bladder and/or support with a harness to facilitate urination.Cardiopulmonary resuscitation status changed to Do Not Resuscitate.Euthanasia is scheduled for 11:00 AM tomorrow (14/03/2026).Client Communication: Update 1 (start of shift)- Vet Name: Ania- Client Name: Michael- Time: 12.30- Medical update: O phoned after discussion with surgery, confirmed want to euthanase Jaxon tomorrow as that is when the family can be present. Do not want to take him home in the meantime due to his nursing needs. We will de-escalate treatments when possible but will continue IVTF as not eating and pain management. Booked euthanasia for 11am tomorrow at O's request. Booked visit for 2.30pm today.Update 2 - Vet Name: Ania- Client Name: Michael- Time: 2.30pm- Medical update: O came for visit - feels Jaxon not doing well and doesn't want to wait until tomorrow for euthanasia. Family will come in for euthanasia, should arrive around 5-5.30pmReferring Veterinarian Communication: Daily update emailed to referring vet : YES/NO Time:    Vital Signs    

Record is CompleteHistory summary:Jaxon is referred to the ARH Surgery service for further evaluation following presentation to the Emergency service yesterday for being unable to rise. Jaxon has had a previous history of a right hindquarter amputation in August 2025 for a tibial osteosarcoma. Chemotherapy was not pursued although he has gone through a few rounds of restaging. The most recent thorax and abdominal CT was performed in January 2026. Jaxon had been presented for that scan with an additional concern over left pelvic limb lameness from around Christmas. His owner reports that he was still ambulating on all 3 limbs. He had also had a consultation with the Surgery service in January regarding left pelvic limb lameness. No additional work-up was pursued then as Jaxon's owner had indicated it was unlikely that they would proceed with any surgical interventions and would mainly be going down the palliative route. Jaxon has been on gabapentin and Previcox (?) since for preumptive possible lumbosacral disease. The owner reports that medications have not improved left pelvic limb ambulation. Over the last couple of days, Jaxon started to demonstrate signs of being unable to rise on his thoracic limbs as well. There were no known events of trauma. The family was away over the long weekend last week and they returned to find that he had deteriorated further. Jaxon is a mostly indoors only dog and he only goes outside under supervision with Michael or Michael's son. He has had to be carried outside for toileting purposes over the past few days. Physical Examination findings:GPE overall unremarkable/systemically stable. Refer to Smartflow for vitals values. Off all infusions for half hour prior to examination. QAR. Lying in right lateral recumbency, requires assistance up into sternal then subsequently able to maintain sternal. Subjectively tonic in thoracic limbs, with paresis/plegia of all 3 limbs. Withdrawal reflexes are slow and incomplete in thoracic limbs, present in left pelvic limb although slow to initiate reflex. Patellar reflex is present. Possible cervical pain on dorsiflexion, equivocal on lateral flexion. Cranial nerves examination unremarkable; gag reflex not tested as muzzled. Cutaneous trunci reflex present, perineal reflex present. Focused orthopaedic examination of left pelvic limb did not identify significant concerns apart from equivocal flinching on direct palpation of femur. Assessment:Tetra (Tri)paresis ddx IVDD, ANNPE, (metastatic) neoplasia, cranial involvement cannot be ruled out considering overall docile/subdued demeanour despite historic reports of aggression. Plan:Discussed assessment of Jaxon with Michael; advised that MRI of the cervical spine +/- brain would be a more appropriate approach to evaluate the nervous system rather than repeat CT. Michael has once again reiterated that the family would not be pursuing any surgical interventions. I have advised that there would be no value in pursuing any further imaging or investigations. Unfortunately, given Jaxon's current presentation with his previous history and regardless of diagnostic results, overall prognosis is poor. To maintain some quality of life, reasonably intense nursing care is required in the form of carrying in and out of the house for toileting purposes, providing bedding, passive range of motion activities etc would be required. As such, euthanasia is a recommendation if the owners cannot perform ongoing nursing care. Michael has decided that he would likely be proceeding with euthanasia and has requested for Jaxon to remain hospitalized for care, until the family is able to convene at ARH tomorrow for Jaxon's planned euthanasia.Jaxon was transferred back to the Emergency service for ongoing care.    Vital Signs    

Reason: CollapsedAppointment Notes: Special payment terms existPresented and seen by Dr   JDA  @ 12/3 5pmRegular Vet: vets in fawknerPresenting Problem: Osteosarcoma 6 mths ago -> amputation. 6 weeks ago LHL injury (slipped) and progressive deterioration since this time.History:Osteosarcoma RHL amputaiton sept 25.Non slip mats around house floorooards but got leg stuck in between two and slipped around Xmas (2.5 mth ago). Ongoing lameness and pain in LHL since.CT and sx dept assessment suggestive of nerve impingement due to lumbosacral foraminal narrowing - but inconclusive.Over last month has been progressively deteriorating.Towel carrying outside since XmasLast 1-2 weeks not able to get up unassisted.Weaker and not supporting his FLs in last 3-4 daysLast 2 days not rolling over to food bowl - having to hand feed (ponly eating chicken)Not produced urination/defecation in last 1-2 days as unable to get up - may have urinated underneath (unsure)When carrying, is now knuckling FLs (las t3-4 days)Last CT clear of chest pathology (2 mnths ago)Gave 1/2 meloxicam tablet today.On further questioning O notes may have had increased resp noises (gurgles) recently.Any current medications: Meloxicam this AM (unsure dose)Any access to potential toxins?: UnlikelyE/D/U/D: Reduced (progressive)Any known conditions: OsteosarcomaDiet: Only eating chicken+dog meatballsExamination Findings:General demeanour: ObtundedTemperature: T: 38.3Cardiovascular: HR: 72bpm, no murumr, SSFP, (utp mm/crt)Respiratory: RR: 28bpm, normal effort, normal BVS, Oral exam: UTPAbdomen: Soft, no free fluid, no nausea elicited, not overtly painful.Peripheral LNs: WNLEyes/Ears: NSFIntegument: NSFMusculoskeletal: No overt hip/stifle painGait: UTPNeurological: Withdrawals HL/FL present. Supoerfiical pain present in HL/FL. Knuckling on all 3 limbs (decreased CP). Cranial nerves appear asnormal (PLR). No appreciable neck/spinal pain. Some rigidity to FLs but able to flex - possible schiff sherrington postureRectal exam: Normal firm feces present, otherwise NSF, no pain/lesion.Urogenital: Cystocentesis sampled (not yet run). bladder moderately filled. Prepuce discharge white, thick, purulent discharge but not evidently UTI based on blood/urine testing.Body Condition Score: 4/9Initial Assessment:Osteosarcoma RHL amputation - no evidence of metastases as of 2 mths ago (CT)Progressive deterioration in ambulation after slipping 2.5 mths ago.Not recovered or improved in any meanignful way during this time - progressive weakness and secondary deterioration.Concern for ongoing nerve impingment vs spinal lesion (cervical vs schiff sherington)Client Communication:Discussed poor prognosisGiven trajectory over last 2 months, unlikely to be able to return to function on LHL.Recommend euthanasia on basis of QoL and welfare to Jaxon.O says this is the likely outcome but:A) wants to confirm diagnosis further - reassess metastases, discuss with sx dept if any further recommendations (but unwilling to pursue any surgical options)B) wants family present for proposed euthanasia if indicated.Discussed options to try to maintain comfort overnight in hospital and discuss possibility of CT repeat with sx dept in AM.1) admit for supprtiove care in hospital and transfer to sx dept in AM for assess +/- CT.2) methadone trial and to go home and represent in AM for possible CT.3) euthanasiaLaboratory:CBC wnl (mild/marginal anemia)Bicohem NSFAdmin panel:Lactate 2.6Ph mild acidosis 7.333Mild hyperK 4.6Urnialysis:Mild WBC presence (5/hpf)Mild increased urobilinogen 70mcmol/LUltrasound Report: NSF on AFAST/TFASTPrognosis: PoorTreatment: Methadone -> fentanyl CRI + IVFTPlan:Ongoing supportive care overngihtTo discuss case with sx dept in AMConsider CT scan (chest, HL/pelvis/caudal spine/full myelogram)Daily update emailed to referring vet: YES/NOFinancial update provided to owner: YES/ NOUrinalysisCollection Method:USG:Appearance:DipstickLeuk:Nit:pH:Protein:Glu:Ket:Ubg:Bil:Blood/Hb:Other notes:    Vital Signs