C09982766 / invoice 10000

Reason: Blood- Any VetAppointment Notes: Paws App Details:Booking Type: ConsultationBooking Vet: - Any -Booking Notes: Frequent bowel movement, sometimes with blood.Pet Insured: YesHistory:Presenting for: Simba, a 4-month-old puppy, presented for ongoing diarrhoea with blood that began in September following a day of inappetence.Diet:- Initially not eating for one day in September- Started eating again but given beef liver which may be upsetting stomach- Currently on puppy food but specific brand V/D/C/S:- Continuous loose motions for approximately one week- Runny, watery diarrhoea occurring every 1-2 hours throughout the night- Blood present during first week, then disappeared but diarrhoea persisted- Some vomiting initially when upset, but has resolved- Minimal saliva production notedCurrent Meds:- Tick and flea prevention - delayed by one week but otherwise up to dateOther:- Similar episode occurred last month- Puppy training scheduled for this week- Poor sleep due to frequent bowel movementsExamine:Mentation: BARWt: 4 kgT: 38°CBehavioural: Cooperative during examination, active and alertAbdominal: Intestines palpably inflamed and angry on examinationRectal: Soft faeces with visible blood observed during examinationAssessment:Gastroenteritis with haematochezia - likely diet-related sensitivity to beef liver, but low-grade bacterial infection possible given presence of bloodPlan:New Meds/Tx:- Flagyl (metronidazole) 1ml BID PO for 7 days - complete full course- Pro-Kolin paste 2 notches BID PO until stools return to normal - give 1 hour apart from antibiotics, store in fridge after opening, available over counter for future episodesDiet Recs:- Royal Canin Puppy Digestive Care 70g daily (35g morning, 35g evening) for one month, then transition back to normal food- Avoid beef liver and beef products- Feed boiled chicken if additional protein needed- Avoid pumpkin and other extras for next weekAdditional Discussion:- If diarrhoea persists after 5 days of treatment, bring fresh stool sample for comprehensive testing (PCR for viruses, bacteria, worms, protozoa)- Expected improvement within 3 days, resolution by day 5- If chicken also causes diarrhoea, may indicate chicken allergy - Purina HA vegetarian diet available but not ideal for growing puppies- Postpone puppy training until stools normaliseClient Comms:- Call next week to confirm improvement before proceeding with scheduled training- Bring stool sample if no improvement by day 5 of treatment- Contact clinic if blood reappears in stool    Vital Signs    Weight: 3.8;       MMColour: pink;       HeartRate: 112;       BodyScore: 5;       DentalGrade: 0;       RespirationRate: 24;       CRT: <2sec;