C10011623 / invoice 10000

Reason: Skin And Back Appointment Notes: ------- Sms reply: YHistory:- Six-week recheck for symmetrical lupoid onychodystrophy (SLO) and intervertebral disc disease (IVDD). Owner reports increased anxiety at home.- EDUD normally.- No vomiting or diarrhoea reported.- History of SLO and IVDD.- Parasite prevention not discussed.Current Medication:- Doxycycline twice daily.- Apoquel one tablet twice daily.- Supplements.- Gabapentin.Medical History:- Symmetrical lupoid onychodystrophy (SLO).- Intervertebral disc disease (IVDD).Examination:BAR, friendly but anxious.Slight proprioceptive deficit noted in right hind limb. No pain elicited on spinal palpation.Toenails appear clean with no evidence of infection. One nail appears to have been recently torn. Three nails are still to be shed. Nails appear less brittle than previously.Weight: 9.5 kg.Assessment:1. Symmetrical Lupoid Onychodystrophy (SLO)- Discussed weaning medications as nails are improving.- Options discussed included stopping doxycycline and reducing Apoquel.- Plan to stop doxycycline. Reduce Apoquel to one tablet once daily. Continue supplements.- Recheck in 5 weeks (27/04/2026).- Monitor for any signs of discomfort or purulent discharge from the nail beds.- If clinical signs worsen on once-daily Apoquel, increase back to twice daily. If there is purulent discharge, restart doxycycline. If signs do not resolve, a recheck is advised sooner. Long-term, food trials may be considered if the condition cannot be controlled.2. Intervertebral Disc Disease (IVDD)- Patient has been receiving laser therapy and acupuncture at another clinic with good results. No back pain reported since commencing therapy.- Discussed increasing exercise to assist with weight management and anxiety.- Recommended a gradual increase in exercise, such as short walks.- Recheck in 5 weeks (27/04/2026).- Monitor for any signs of back pain, reluctance to move, or neurological deficits.- If clinical signs recur, a recheck is advised.Treatment:- Written script provided for Apoquel.Plan:- Stop doxycycline. Reduce Apoquel to one tablet once daily, starting from 11/03/2026. Continue current supplements.- Monitor for any purulent discharge from nail beds or increased discomfort. Also monitor for any signs of back pain.- If nail beds become infected, restart doxycycline. If discomfort increases, increase Apoquel to twice daily. If there is no improvement or patient deteriorates, return for re-examination. Recheck scheduled for 27/04/2026 at 5:10 PM.    Vital Signs