C09977116 / invoice 10000

Reason: Recheck, diarrhea

History:
Pipi will not tolerate any probiotic, powder or paste. Will take O's human probiotic 
Faeces is a bit  better, firm and dry at the beginning but rest is watery.
This has been going on for 2 weeks now. 
Currently on gastrobiome + renal hills; added new royal canin gastro to the mix
Hx of diabetes (well controlled), enteropathy, renal disease; bloods performed last week ruled out pancreatitis. 
Still eating well. 
Has 4 cats at home, O's friend is boarding her cat with them for 1 month.
Pipi doesn't seem outwardly stressed by the new arrival but O feels she is uncomfortable and stressed from the diarrhea 
UTD milbemax due in 2 weeks

Vital Signs:
Temperature:  36.7C
Heart Rate: 172  bpm 
Pulse rate:  172
Pulse character: strong and synchronous. 
Respiration Rate: 40. 
MM: pink, moist
CRT: <1 sec

Dehydration assessment: Euhydrated MM moist no skin tent

PHYSICAL EXAMINATION:
Appearance: BAR; BCS 6/9
Eyes: nad. no redness,discharge, blepharospasm. responds to visual stimulus
Ears: nad. no debris or inflammation
Nose: nad
Oral Cavity: G4 dental disease, marked calculus build up particularly hind quadrats 
Cardiovascular: Auscultation no murmur detected ,pulse quality normal ,rhythm regular
Respiratory: RE normal , auscultation normal
Abdomen: soft and comfortable, no obvious mass palpable today
Musculoskeletal: ambulatory all 4 limbs
Neurological: appropriate mentation
Integument: free of ectoparasites or other skin lesion
Peripheral LNs:Normal size, symmetrical
Urogenital: not assessed
Rectal exam: not examined

Assessment/Problem List:
1. Ongoing diarrhea
2. Known diabetes, CKD, enteropathy
DDx: indiscretion vs. gastritis vs. chronic enteropathy vs. small cell lymphoma vs. stress vs. associated with comorbidities; GI vs. extra GI vs. other

Plan:
O will bring in faecal sample to rule out parasites/infectious causes as she is worried
Change diet to gastrobiome only in the mean time until diarrhea has resolved, instead of mixing 1 whole sachet of fortiflora to mix in half sachet twice daily, maybe this will be more palatable?
Gabapentin 100mg 1/2 capsule BID to manage any stress associated with his current condition or added stress from boarding cat. 

I don't believe imaging has been discussed yet and don't see any attachments of abdo u/s, can consider for next step if not already done.

Neutrophils 16.39 2.6 - 15.2 x10^9/L
rest haematology nad

called O and relayed above. O reports Pipi seems better, doesnt like prokolin paste, so will try probiotic powder instead