C09990623 / invoice 10000

Appointment Notes: R/V review pain? had stitch up at emergency see hx attached 3 days ago. is on meloxicam - LB?????History: Presented for a recheck of a left foreleg wound sustained three days prior after running into a park bench. The wound was closed with a staple at an emergency clinic. Post-incident, the patient was initially walking on the leg but later developed fast breathing, requiring a second emergency visit where a 24-hour pain relief injection was administered. The owner reports an increased limp, lethargy, and intermittent whining over the last 18 hours. The patient is currently receiving Meloxicam, but the owner is concerned it provides inadequate analgesia, particularly during the day. Appetite and interactivity are normal.- Significant history: Left foreleg laceration sustained 3 days ago, closed with a single staple.- Current medications: Meloxicam 0.1mg/kg PO q24hExamination Findings:- Demeanour: BAR Heart Rate: 120 bpm= PR, Respiratory Rate: , MM pink CRT<2s, Temperature: 38.6°C BCS: 5/9- Eyes: NAD.- Ears: NAD.- Oral: WNL.- Nose: NAD.- Peripheral lymph nodes: WNL.- Cardiovascular: Tachycardia likely due to excitement, regular rhythm, no murmur.- Respiratory, breathing: normal effort, auscultation clear.- Urinary/Genital: normal external anatomy.- Skin: A single staple is present on the left foreleg. The wound is healing well with minimal inflammation. Mild localised swelling ("puffy") noted on palpation. Normal skin tent.- Abdomen: soft, comfortable on palpation.- Rectal examination: not performed.- Neurological: Normal mentation, no ataxia, detailed exam deferred.- Musculoskeletal: Lameness reported on the left foreleg. The wound area is not overtly painful on direct palpation.Problem List:- Left foreleg pain and lameness- Left foreleg stapled wound- Suspected breakthrough painAssessment:A 7-month-old male Golden Retriever X presented for ongoing pain and lameness following a stapled wound repair on the left foreleg. The wound is healing appropriately, but analgesia appears insufficient with the current protocol. Pain is likely exacerbated by skin tension around the staple during movement.ddx:Plan:Treatment Plan:- Continue Meloxicam as previously prescribed.- Add Paracetamol 10-15 mg/kg (3/4 to 1 of a 500 mg tablet) orally up to every 8 hours as needed for breakthrough pain.Client Communications:- Discussed supplementing current pain relief with Paracetamol for better multimodal analgesia.- Advised on correct Paracetamol dosage for patient's weight.- Issued strong warnings regarding Paracetamol toxicity in cats and Ibuprofen toxicity in dogs.- Advised the wound prognosis is good.- Advised the owner they can remove the staple at home next week.?????    Vital Signs    Weight: 26.8;