C10030894 / invoice 10000

Appointment Notes: HL Xrays  Objective: BAR, friendly HR/PR: 80RR: 12Temp: 38.5CRT: P, M, CRT <2sStatus: ASA 1Laboratory: PAS declinedTreatment: Premed @ 9:12am > Methadone(10mg/ml) 0.6ml IV> ACP (2mg/ml) 0.26ml IVInduction @9:20am> Propofol 13ml Intubated with cuffed ETT 9.0 and maintained on iso in O2 1.0L/minImaging: 1 > View: RL stifle Factors: 62kV 1.8mAs 2 > View: RL pelvis Factors:  70kV 4.5mAs 3 > View: LL stifle Factors: 62kV 1.8 mAs 4 > View: VD pelvis Factors: 72kV 14mAs  5 > View: PA L stifle Factors: 60kV 6.3 mAs  6 > View: PA R stifle Factors: 60V 6.3 mAs Quality: adequate positioning, exposure and collimation. Labels present. Measuring ball and marker missed lateral pelvis. No artefacts.Findings Normal:> No obvious long bone fractures, no joint effusions, no evidence of bony growths/neoplasia/inflammation. Bone density wnl.> Faeces in colon - normal consistency Findings Abnormal:> No obvious abnormalitiesPhysical exam:>RHL: -ve cranial draw, -ve tibial thrust, no stifle effusion appreciatedNo obvious swelling or instability palpated across length of limb Purulent discharge in interdigital space 4-5, cleaned with dilute chlorhexidine, mild skin erythema, no obvious sinus or ulceration.> LHL:-ve cranial draw, -ve tibial thrust, no stifle effusion appreciatedNo obvious swelling or instability palpated across length of limb No wounds notedConclusions:No evidence of MSK abnormalities appreciated on radiographsSuspect LHL lameness due to: soft tissue trauma - ligament, tendon, musculature. vs Skin inflammation - interdigital furunculosis, current or historic FB. vs otherAnaesthesia finished @10:00amRecovery - Smooth Pain relief - Currently on meloxicam and gabapentinPlan:Continue on NSAIDs and strict rest for 14 days Meloxicam 2.5mg PO SID for 14 daysIf still no improvement or worsening - consider CT for increased specificity vs MSK assessment with JCEKS dischargedShowed x-rays and no bony changes to explain lameness. Good news that no sign of cruciate injury, but unsure of cause. Suspecting soft tissue injury. O reports has been on and off lame over the last 6 weeks - could be exacerbating tendon or ligament injury. Hard to keep her quiet at home, loves to chase things in the garden and generally follows o around everywhere. Discussed purulent discharge at bottom of paw - unsure if this is related or incidental finding. Option to use malaseb for paw bathing over the next few days to cover. O opted to monitor for now but will pick up malaseb if notices discharge at home.Plan to keep strictly rested 2 weeks (on lead to toilet, prevent zoomies), consider increasing gabapentin to 400mg PO BID, can also add in trazodone if needed.INI with strict rest, then consult with JCE to try to localise +/- CT scan    Vital Signs