C09991346 / invoice 10000

05/03/2026 NURSE: OM

REASON: Reason for presentation: Pre-medication bloods for Metacam script renewal. C/O L hindlimb lameness.

HISTORY:
- C/O L hindlimb lameness for 1+ week.
- Sudden onset after jumping up quickly.
- Initially non-weight bearing, now partially weight-bearing.
- Re-aggravated after jumping up again.
- Prior Hx: 2 TPLOs, elbow surgery.
- Allergic to cephalexin.

APPETITE: E+DDU normally.

ACTIVITY: Good.

DIET: NAD.

TOILETING: NAD.

CURRENT MEDICATIONS: On Metacam (meloxicam) for 6/12 for arthritis.

CLINICIAL EXAM:
- Mentation: BAR
- MM: Pink
- CRT: <2s
- Oral and Dental Score: Not assessed
- Eyes: Symmetrical and clear. Mild scleral injection bilaterally, owner reports this is normal stress response.
- Ears: WNL. Not gunky or malodorous.
- BCS: Not assessed
- Lumps: Not assessed
- Abdominal: Soft and non-painful on palpation.
- Lymph nodes: WNL.
- HR: 120bpm. No murmur auscultated.
- RR: Not assessed
- Temp: Not assessed
- Urogenital: Not assessed
- MSK: Pain on extension of L stifle, pulls away. No crepitus felt in either stifle. Pain on extension of both hips. Shaking in L hindlimb noted.
- Skin: No licking of toes.

ASSESSMENT:
- Pending renal panel results.
- Suspected musculoskeletal pain/discomfort in L hindlimb and hips, likely secondary to osteoarthritis.

DISCUSSION:
- O advised multimodal pain relief approach for arthritis management is best practice.
- Discussed adding adjunctive pain relief to Metacam.
- Options discussed:
- Paracetamol (Parnell)
- Pregabalin
- Ketamine SC injections (monthly)
- Beransa (monoclonal antibody) injection
- O advised of potential adverse effects of Beransa, including rare progression of OA and potential kidney effects when used with NSAIDs.
- Agreed to start with paracetamol and re-assess.
- O consents to plan.

TREATMENT:
- Bloods collected for pre-anaesthetic/renal panel.
- Small bottle of Metacam dispensed for use until online order arrives.
- Prescription for meloxicam provided (1 repeat).

PLAN:
- Start paracetamol at 3/4 of a 500mg tablet BID with food.
- Monitor for improvement over next 2/52.
- O to contact clinic if no improvement, to consider adding pregabalin.
- Follow up regarding blood results

BLOODS ALL NORMAL! :)