C10030054 / invoice 10000

Reason: RL - Vaxes (MM)Appointment Notes: Rambo (Dog) - Vaccinations [Veterinarian : Dr Rachele Lowe (Preferred Clinician)] - VaccinationsWeb BookingClient name: claudia GallardoContact number: 61404893400Email address: claudz00@hotmail.comPatient name: RamboHistory:Presenting for: Rambo, a nearly 17-year-old dog, presented for routine vaccinations and ongoing management of chronic skin disease and eye issues.Historical Conditions:- Chronic skin disease with history of scaling and scabby lesions- Periocular dermatitis - previously seen by specialist, advised to keep area clean and apply ointment twice daily- Dynamic airway disease- Suspected Cushing's disease- Age-related disorientation and anxiety- Myoclonus - resolved on current medication- ArthritisCurrent Meds:- Melatonin for 3 months - owner reports skin improvement- Maxidex eye drops- Eye lubricating drops- Anxiety medication given prior to grooming appointments every 2 monthsLifestyle Risk Factors:- Recent home renovations with dust and paint exposure - now completed- Regular grooming requiredOther:- Owner reports skin condition has improved significantly on melatonin- Anxiety medication effective for grooming - groomer noted marked improvement in behaviour- Some age-related behavioural changes including occasional disorientationExamination:Mentation: BARBehavioural: Cooperative during examination, accepts treats readily, some anxiety around veterinary team but manageableEyes: Sclera mildly red bilaterally, periocular dermatitis present but stable and improved, not considered severeEars: Clean bilaterallyCardiovascular: Chest sounds clearAbdominal: Unremarkable on palpationLymph Nodes: Prescapular lymph nodes normal, no progression notedIntegumentary: Chronic skin disease present but much improved - skin pinker and softer than previously, some scaling in groin area, overall less scabby lesions, healing appearance notedNeurologic: Mild myoclonus noted but resolved on current medicationMusculoskeletal: Low muscle mass in both hind legs, worse on right side, reduced range of motion in hips particularly right side, arthritis palpable in sacroiliac areaAssessment:Chronic skin disease - significantly improved on current melatonin therapyPeriocular dermatitis - stable, likely exacerbated by recent home renovationsAge-related muscle atrophy and arthritis - particularly affecting hind limbs and sacroiliac regionAnxiety - well controlled with pre-medication for groomingOtherwise stable for agePlan:Vaccinations:- Kennel cough vaccine administered- Leptospirosis vaccine administered - discussed new vaccine with additional strains but opted to continue with original formulation given low local risk and recent case was in relocated ownersNew Meds/Tx:- Cytopoint injection administered for ongoing skin management- Facial hair trimming performed around eyes to assist with hygiene and eye careAdditional Discussion:- Continue current melatonin therapy given excellent response over 3 months- May trial reducing bathing frequency as some dogs respond better to less frequent bathing- Continue twice daily cleaning around eyes, can discontinue medicated ointment and trial cleaning only given improvement and completion of renovations- Anxiety pre-medication to continue prior to grooming appointments given excellent results    Vital Signs    Weight: 7.4;