C09985544 / invoice 10000

Spoke to Lyndsey about differences in drug warning labels between Australia and the USA 
Emailed her a couple of documents from drug company in regards to its safety around using it concurrently with vaccinations etc. 

Reason:  recheck skin 
History: 
Had some pus around his penis - was recommended to clean with dilute iodine 
Seemed to get worse but right before presenting here it looked better 
Not really licking at prepuce 
Was dispensed Zenrelia previously - received one dose, O very concerned about information she has ready about this 

Current medications: none - no gabapentin or trazodone today 

Examine: 
BAR, highly anxious
Prepuce and penis look good - no discharge present or discomfort on extruding 

Assessment: 
- previous prepucial discharge has resolved - no further treatment needed for this
- discussed concerns with zenrelia - biggest issues O has is that she has ready it should not be given within 28 days of vaccination, also read it is an immunosuppressant so does not feel comfortable continuing this. Discussed main concerns with zenrelia and vaccinations are based on a study in the US - the same concerns have not been reported here and drug reps here have advised they are safe to be used together. Also advised zenrelia is an immunomodulatory drug and does not actually suppress the immune system - just acts on interleukins that cause itch. Still not very satisfied with discussion - advised will discuss with HV who will reach out to her on Tuesday, and contact local drug reps to see if we can get a written statement confirming safety. O happy with this  

Plan:
Monitor for further prepucial discharge