C10027065 / invoice 10000

Reason: Barking At NightBooking Notes: Dementia barking at night currently on 2 gabapentin at night but barking episodes every hour last night and becoming more frequentHistory: After more sedatives as he is being very disruptive at night, waking up frequently and barking at nothing and seems anxious as he does it, owner describing at as "ghost barking". This seemed to first start about 4 years ago and so went onto Endep initially which later had a dose increase and then later neurontin added with doses gradually increased over time until reached current dose for both which is Ednep 50mg bid, Gabapentin 300mg am and 600mg pm.Owner is noting variable changes in hearing and thinks his sight although did have eyes assessed by Ziggy chester and she didnt identify any problems.Owner says it is just cognitive declined and wants more meds.Examine: Alert. Seems reasonably lucid in consult and vision and hearing ok responding to command to sit and not bumping into things in the room. Mildly opaque lesion in medial part of left cornea abutting the TEL of a few mms wide in a halo shaped but it's only partial and so wont be affecting vision at all.Assessment: Symptoms as described by owner of worsening night-time restlessness could be consistent with dementia. Other ddx include medical issues such as brain tumour or other SOLs, metabolic or endocrine diseases.She's not wanting any diagnostic testing.Plan: Add Acepromazine to the current drug regime for night time sedation with acceptable dose range provided and owner to experiment to reach optimal dose. Can have repeats.Also trial Vivitonin for 1 month - 100mg bid. Can have repeats if effective. Keep light on at night for him.Selegeline is the recommended drug for cognitive decline but would have to discontinue endep if we were to try this.    Vital Signs    Weight: 26;