C10013145 / invoice 10000

Reason: Ghe Check & Meatacam Request, Blood Test. Appointment Notes: Overdue remindersHistory: Harley presents today for repeat bloodwork & GHC. Harley had an FHO at 12m of age & has been on chronic meloxicam since. Owners trialled reducing meloxicam throughout Harley's life, however he has been on daily dosing for the past 3 years (15-25 unit dosing). Harley also has a history of nasal philtrum low grade/grade 2 MCT in September 2025. Owner reports that Harley is doing well, with no major concerns. He has been EDDU normally, with no vomiting or diarrhoea. Stool consistency has been normal, with no evidence of melena.Harley's mobility is reasonable, with most days fairly sound & others with lameness/more notable gait changes. Owner noted that Harley had a focal area of alopecia over his lip a few days ago, which was potentially red. This has since resolved & suspects it was a scratch. Current meds: - Meloxicam 15-25 unit PO SID- 4cyte PO SIDExamination: T: DNT         MM: pink & moistP: 96 bpm      CRT: 1-2s R: pantingDemeanour: BARHydration: euhydratedWeight: 28.0 kg (+1.2kg)BCS: 6/9MCS: 2/3Cardiovascular: no murmur auscultated, normal rhythmRespiratory: normal bronchovesicular sounds bilaterally, normal effortAbdomen: soft & comfortable on palpationPeripheral LNs: WNLOcular: clear & bright, no evidence of blepharospasm or sclerititsEars: clean with nil discharge or erythemaIntegument: clean healthy coat- focal 1-2mm alopetic area on R nasal philtrum, flat surface - previous surgical excision, nil erythema. Oral exam: periodontal disease 1/4Musculoskeletal: mild lumbosacral hyperpathia, remainder MSK exam deferredNeurological: mentation appropriate, full exam deferredRectal: deferredLaboratory: CBC + MBA - pending IDEXXAssessment: Harley presents today for general health check & repeat bloodwork due to chronic meloxicam usage for his DJD. Bloodwork has been sent to assess renal function. Whilst Harley has apparently been tolerating daily meloxicam well, alternative therapies may also be suitable with limited detriment. Examples of pregabalin +/- paracetamol have been discussed with the owner, to reduce or eliminate meloxicam usage. Whilst Harley's nasal philtrum region appears unremarkable, with a mild injury (scratch) the most likely aetiology - given previous diagnosis of MCT; caution is recommended. Owner has been advised to closely monitor the area for any changes to size, shape, colour or general appearance. Harley is a fairly anxious dog, so alongside small area - sample collection/FNA would be not possible whilst awake. Treatment: - Meloxicam 15-25 unit PO SID PRN- Pregabalin 75mg PO BID- Paracetamol 500mg PO BIDConsent has been given by the client to proceed with this treatment  -  YesPlan:Consider new medications - dosing as belowMonitor lip for changesCall with blood resultsClient communication:- Discussed potential nephrotoxicity vs gastric ulceration 2" to NSAIDs, with other medications preferred if pain is well controlled. Given owners have not even attempted to discontinue over the past 3 years, it's been suggested to see what happens when Harley does not receive his full dose/any dose of meloxicam. - A trial of pregabalin will be commenced, ideal dosing 1.5 capsules BID, so could give 2 in the morning & 1 in the evening if difficult. Due to new medication, 1 capsule will be trialled at first - however this can be adjusted as needed. - Paracetamol 500mg can be used on a BID basis alongside pregabalin as a substitute for meloxicam. - If unable to discontinue meloxicam safely, trial giving to the lowest possible dose to reduce side effects, however seems very well tolerated--- 11/03/2026 07:56:40 AM TTB:Examinations - Resolved - SMS Sent TTB - Owner to follow--- 11/03/2026 08:09:53 LHS:Hi Lyn,Harley's bloods are all normal. He has very mildly elevated cholesterol levels, however this can be influenced by recent meals/treats fed. I'll touch base in a few weeks to see how he is going with the pregabalin. Thanks, LaniGx JindaleeBloodwork attached: CBC: unremarkableMBA: - creatinine 100 (50-130) WNL- urea 7.5 7.5 (2.5-10) WNL- SDMA 8 (0-14) WNL- mild hypercholesterolaemia 10 (3.5-9)- mild lipase elevation 501 (0-250)    Vital Signs    Weight: 28;