C10020961 / invoice 10000

Reason: RevisitAppointment Notes: ajsReason: History: Current Medications:Metoclopramide 3/4 tablet before dinner - feels like in last 2 nights that seems to have helped settle a bit. Can have up to 1.25 tablets of 10mg if needed.Peptosyl no obvious response and REALLY didn't like it so don't think that will be helpful. Antinol Canine ceuticals gut restore 3/4 of the standard dose Senior: discuss if needed.Vaccinations up to date ? Examine: Diet: Dental/oral cavity: Eyes: Ears: Cardiovascular/respiratory: GIT/abdomen: Urogenital: M/skeletal: Skin: Lumps: Lymph Nodes: Behaviour: Assessment: Treatment: Plan: Script status:  Checked and updated? Yes/NoVaccination / Blood test / Catrophen Reminders up to date? ADJUST ACCORDINGLYRevist/ Recall/ Reminder:Verified: NoHistory:Presenting for: Tulley presented for follow-up acupuncture treatment for upper back issues and ongoing gastro symptoms.Historical Conditions:- Previous notes received from Mount Barker including blood work and ultrasound from Xander- History of chronic atopic dermatitis- Upper back pain/discomfortCurrent Meds:- Metoclopramide 10mg tablets - currently giving 3/4 tablet 30 minutes before dinner for last 3 nights (previously tried 1/2 tablet for several nights with minimal effect)- CanineCeuticals Gut Restore powder - working up to 3/4 dose, currently just under 1 scoop- Peptozol BID - discontinued after second dose due to patient refusing medication (bit owner)Other:- Owner reports improvement over last 2 nights with increased metoclopramide dose - patient able to settle and go to bed rather than requesting more food- Receiving physiotherapy from Johanna including massage and laser therapy along back - patient initially resistant but now comfortable with treatment- Next physio appointment scheduled for WednesdayExamination:Behavioural: Calm and cooperative during examination. Readily accepted treats throughout procedure. No signs of stress or anxiety.Integumentary: Coat soft and shiny. Bathed frequently.Assessment:Upper back pain - responding well to current multimodal approach including acupuncture and physiotherapyGastro symptoms - showing improvement with increased metoclopramide dosePlan:Medications/Treatments:- Acupuncture performed today targeting gut points and upper back points as per previous session- Continue metoclopramide 3/4 tablet 30 minutes before dinner nightlyNew Meds/Tx:- Chinese herbal powder prescribed - start with 1/2 teaspoon and gradually increase to 1 level teaspoon once daily with food over 1-1.5 weeks. Mix into food. Store with dry spoon and ensure proper sealing to prevent clumping.Additional Discussion:- No contraindication between acupuncture and physiotherapy - can be performed same day- Plan to trial reducing metoclopramide in 2 weeks to assess if underlying condition improving- Chinese herbs may take 2-3 weeks to show cumulative effect- Confirmed no interaction between Chinese herbs and current CanineCeuticals supplement- Discussed that adding multiple treatments simultaneously makes it difficult to determine which intervention is most effective    Vital Signs    Weight: 25.5;