C09974096 / invoice 10000

Appointment Notes: Special payment terms exist, Overdue remindersRecord Entered by: Hana KurniantaRecord checked by:History:Presented for review.Client reported Bellini is doing really well at home.12kg now (normal weight usually 11.5-12kg). No weight loss.Diet: kibbles (scratch lamb), Lader pet anxiety treat (kangaroo protein) 1-2x/day, occasional other protein treats. No human food (strict!).Eating normally. Client reported appetite better (likely due to B12 supplementation).Drinking normally.Normal energy level, back active. But after playing now seems to be slower, but if there's stimulation (other dogs, ball) will be happy to play again.Usual walk: minimum 3km per day, usually closer to 6-8km overall per day, usually also playing at catching balls on top of thatNo vomiting.Does have exercise induce diarrhoea, only one occasion, then normalize afterwards. Not all the time, every now and then. Has improved in terms of consistency and frequency, normal brown colour, no mucus or blood. Otherwise perfect poop. No straining, even better consistency than before.If drinks too much water after activity, regurgitated. Used to do that all the time, since on the probiotics and vitamin B12 hasn't been doing that often at all (improvement). Previously doing every day, now just roughly once a week.Found her to be burping start 2-3 weeks ago. Static, 1-2x/day. Seems to be after drinking a lot, but not always, not really associated with anything.No coughing or sneezing noted at home, occasional reverse sneezing.Vaccination and deworming UTD.Client reported no issue with giving her medications, been mixing with food.Was on probiotics a few years ago, and improved even after stopping the probiotics.Client recalled she had burger patty plain beef during birthday (end Jan), from McDonalds no salt no pepper. Could have triggered previous GIT episode.Medications:- Cobalazorb- Probiotic (Fortiflora)- 1/4-1/2 teaspoon of psyllium huskPhysical examination:BCS: 5/9Temperature: 38.1Heart Rate: 96, sinus arrhythmiaPulse Rate and quality: normal synchronous pulseMucous Membranes: pink and moistCRT: <2sIntegument: skin tent wnl, no obvious evidence of inflammation on physical examination, seen scratching intermittently during consultationRespiratory System: panting (excited and greeting everyone), normal respiratory effort, lung sound normal, occasional stertor when super excitedDigestive/Oral: underbite noted, clean teeth. Comfortable on abdominal palpation, abdomen soft and pliable, no mass, no organomegaly, no free fluid or other abnormalities notedGenitourinary: unremarkableMusculoskeletal: unremarkableNeurological: normal mentation, ambulatory, no ataxia no circling, no knuckling. Full neuro exam not performedLymph Nodes: Peripheral lymph nodes unremarkableEyes: no discharge, no swelling, no external abnormalities. Full opthalmology exam not performedEars: clean, no evidence of inflammation, no discharge, no swelling, comfortable on palpationProblem list:1) Exercise induced soft stool 2) Regurgitation3) BurpingAssessment:Suspect underlying food related enteropathy, improving with strictly no human food diet. Need further work up to confirm the diagnosis, however since Bellini is doing well with current management plan, discussed not to pursue the further work up at this stage. To consider if not doing well despite continuing current management plan.Discussed with client on potentially changing the diet to hypoallergenic, to see whether there will be further improvement. Client's concern are cost, time (if need to do home cook diet) and the fact the Bellini is a fussy eater. Since there are improvement at this stage, client is keen on continuing this diet first and see how Belline responds. Client happy with the current progress so far, and happy to continue with current supplementation.Discussed giving more time for the cobalamin supplementation before checking the cobalamin level in the blood (to give at least 2 months of having the supplementation). Previous blood was normal apart from mildly elevated ALT, discussed not repeating the blood today as Bellini is doing well. Consider doing regular annual blood tests during annual check/vaccination.Plan (incl. alternative options):Continue cobalamin, probiotics and psyllium husk at the same dose and frequency.Phone update in 4-6 weeks time, assess if there's any further improvement at that time. Client to monitor her symptoms until then (exercise induce soft stool, regurgitation, burping, other symptoms). Earlier review if there's concern.    Vital Signs    Weight: 12;       MMColour: Pink;       RespirationRate: panting;       HeartRate: 96;       Temperature: 38.1;       CRT: < 2 sec;