C09986317 / invoice 10000

Reason: Diarrhea Past 3 Weeks - In Car O to Peak To HL FirAppointment Notes: Overdue reminders Loose stools and excessive flatulence for 2 weeksHistory:Loose stools for past 2 weeks, not entirely liquid but very softFed rice and boiled chicken with no improvementPro-Kolin Advanced tried with temporary improvement then recurrenceExcessive flatulence approx 10 times per hour, malodorousHistory of pancreatic enzyme deficiency, currently on CreonCurrent medications: Prime 100 diet, Creon, Antinol, Apoquel (started December 19th)Occasional treats include chicken wings and beef DOG TREATSTwo meals dailyPrevious skin issues with scratching and bleeding under limbs, improved on current treatment - apoquel works. Cytopoint not effective.Going to boarding for 2 weeksExamination:O declined PE today - not performedAssessment:loose stoolsflatulenceAtopic dermatitis stable on current treatmentPlan:Metronidazole 10 daysPro-Kolin small tube dispensedContinue Apoquel SIDDiscontinue rice and chicken dietReturn to Prime 100 dietContinue current skin treatmentConsider faecal sample if no improvement after boarding - PCR + f/f May req US if not resolvedDiscussed annual Bravecto injection as alternative to tabletsConversation with owner:Owner declined physical examination to avoid stressAdvised to continue Apoquel through boarding to prevent skin flare-upDiscussed that Apoquel unlikely cause of D+ as started in December with no initial issuesRecommended returning to normal diet as rice and chicken may be contributing to ongoing issuesAdvised stress from boarding may temporarily affect stoolsFaecal sample recommended if no improvement post-boardingAnnual Bravecto injection discussed as alternative to tablets    Vital Signs