C09995621 / invoice 10000

Reason: Check Up DSAppointment Notes: ------- Sms reply: YReason: Arthritis management - query long-term anti-inflammatory therapyHistory:Reason for consultation: Can Ellie stay on anti-inflammatories long-term?-- Duration: Recurrent episodes of pain and stiffness when off medication---- Previous courses of anti-inflammatories provide good relief; symptoms return within 2 days of cessationAny other issues:Up to date with prevention:      --       -- type - Medications on currently - Previcox 1.5 tablets daily (10 day course prescribed previously)Examine:-- BCS: -- Temp: 38.4 -- MM:  pink-- CRT: 2 secs-- Cardiovascular:      -- HR:     -- No obvious murmurs or arrhythmias     -- or murmur - grade -  -- Respiratory:     -- RR:      -- Respiratory effort - No increased insp or exp effort     -- Respiratory sounds - Normal bronchiovesicular lung sounds     ---- Abdomen:     -- Pliable, not painful, no masses obvious on palpation    ---- Oral:    -- Examination:    -- Dental score: -- Eyes:     -- No abnormal ocular discharge,    -- No conjunctivitis    -- normal sclera,     -- Pupils symmetrical.     -- Retinal examination normal.     -- Lens normal position and normal opacity.     -- Eyelids normal-- Nose:     -- Normal confirmation or brachycephalic    -- No sneezing.     -- No nasal discharge.     -- Normal symmetry. -- Integument:     -- Clean coat,     -- No dermatitis or skin lesions present.    -- Normal skin turgor    -- No fleas or externa parasites    ---- Ears     -- Left ear - normal canal with no discharge. Normal pinna    -- Right ear - normal canal with no discharge. Normal pinna-- Lymph Nodes:     -- all palpable external lymph nodes normal size and shape-- Musculoskeletal:     -- Ambulatory with no lameness.     -- Joints palpate normally.     -- Normal musculoskeletal exam    ---- Neurological:     -- Mentation - BAR.     -- Normal CN function.     -- No ataxia noted.     -- Normal neurological exam     ---- Rectal exam: -- Reproductive:     -- n/a (de-sexed)     -- or normal reproductive examination     -- or prostate/testicles/penis normal    -- or vulva/mammary tissue normal -- Behaviour: -- -- Problem list: 1. ArthritisPlan: Blood test (biochemistry only - liver and kidney function) prior to long-term NSAID therapyContinue Previcox 1.5 tablets daily for 1-2 months solid therapyAfter 1-2 months, may trial dose reduction by quarter tablet at a time; minimum dose 1 tablet dailyDaily dosing preferred over alternate day dosing to maintain inflammatory controlConsider environmental factors - winter may require higher dosesIf slip or fall occurs, increase to normal dose for 1-2 weeks then retry lower doseRepeat bloods in 6-12 months to monitor organ functionMedical insurance - 100% coverageQuote/EstimateLaboratory: Biochemistry (liver and kidney function)Assessment: Differential Diagnosis: Diagnosis: ArthritisTreatment: Previcox 1.5 tablets daily; may reduce to 1 tablet daily after 1-2 months of solid therapy; daily dosing essential; monitor with blood tests    Vital Signs    Weight: 78;