# .

Script
Pt states needs scripts
Reports good compliance and no missed doses
No SEs as per pt
Continue current doses

# .Wtloss

A. Discussed intermittent fasting

12 hr window eating
No food post sunset
can extend slowly upto 16 hrs
Build habit over 4 -6 weeks

B. Discussed dietary changes

Caloric deficit -300/day at least
When -3500 cal deficit = 1 pound wt loss

C. Medications discussed
BMI>35 , eligible for pharmacotherapy
Pt doesnt seem too keen for medications at this stage
Advised to look up saxenda, duromine, orlistat and we can further
discuss next time
Basic +ve and -ves of these meds discussed

# .exam
Alert, no SOB
Afebrile
No inc WOB
Throat - no erythema, no tonsillar swelling or exudate
Chest clear
Abdo SNT
No pedal edema

# .93645
Here for COVID Booster
Not had COVID in past 6 months
Last COVID Vaccine >6 months
Had COVID vaccine x 5 already
No allergy
SEs and risks explained
Pt Well, afebrile today
Verbal consent procured
Vaccine administered
Advised to wait in waiting room for 15 mins
No complications post

# Rash mx
Use antihistamine if itchy
Avoid hot showers
Avoid Soaps/chemicals
Moisturise - QV cream
Menthol cream for cooling effect
if not improving, review again
+/- steroid cream