C09990717 / invoice 10000

S: recheck post pancreatitis. Now diarrhoea: Idexx PCR with ova, prepaid prior to ex lap and biopsies
RC after hospital stay
History:
-Now diarrhoea, almost daily despite feeding IBD prescription food
- Occasional vomiting when empty stomach for ~3 hours
- Diarrhoea new feature - previously vomiting predominant
- Probiotic given daily
- IBD prescription food combined with normal food 1-2x/week
- Appetite very good, not fussy with food

EDDU: Appetite normal,  normal, occasional vomiting when hungry with empty stomach, diarrhoea almost daily
Diet: Normal food with IBD prescription food combined 1-2x/week, chicken

Medical condition: Suspected IBD, previous intestinal signs

Medication: Probiotic daily

Kept: Indoor/outdoor, lives with other cats

Parasite control:

Behavioural concerns: More aggressive since last visit

Examine:
Weight change: Slight weight loss noted
Abdominal palpation - Pancreas palpated, not painful

Assessment:
- Suspected IBD
- Possible bacterial overgrowth in gut
- Low grade lymphoma to rule out

Treatment:
- Continue probiotic daily
- Taper medication

Plan:
- Faecal PCR to be collected and submitted (comprehensive panel to rule out treatable pathogens)
- Exploratory surgery with intestinal biopsies to be pre-booked (can cancel if PCR reveals treatable cause)
- Overnight stay post-surgery
- Intradermal sutures to be used (no external stitches)
- Owner to drop off faecal sample when collected
- Will call with PCR results

PO Call:

No answer, left vm, sent txt. 
DK

O called back spoke to IW 22/01:
eating wet food and drinkinhg well, urinating well, still has some D+ (after she had eaten last night and this morning)
Putting toward CB, will update DK when she is back from lunch :)

CB - happy with this so far. diarrhoea may take a few days to resolve

O called back, IW lshared CB advisory - O still a little concerned about Liquid D+ ( 3rd time today ) 
O may call tomorrow morning before she comes in with Meedle, if she notices any other symptoms 

O called back spoke to IW 22/01
Putting toward CB, will update DK when she is back from lunch :) pls see comms from O IW

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JY - Please dispense Pro-kolin @ 2ml orally TWICE daily if diarrhoea persists on Friday

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EG called o 23/1
o said she hasnt had any D+, EG asked if she wanted to try the meds but o elected to wait to see what her stool was like today and will call if she has D+

Hospitalisation - Day (3) - pancreatitis, CKD, IBD

(AM) Vet (CB) Nurse (DK)
S: Demeanour (BAR) 
O: IVF (hartmanns + 20mmol KCl) volume infused (162) and current rate (12) Weight (4.72) HR (160) RR (28) T (38.5) CRT (<2s) MM (pink,  moist) 
fed? (y) eating? (ate all overnight) water (y) drinking? (Y 30ml) defecation (++ diarrhoea ) urination (++++) pain score (0/6) other ()
A: (improving)
P: treatments given (buprenorphine 0.25ml IV, cefazolin 0.48ml IV, zofran 1/4 tab PO, prokolin 2ml PO) nursing care ()
Client communication (y) invoice updated (y)

o visit, consider home if eating
dispense synbiotic
continue zofran and buprenorphine at home, +/- mirtazapine
IBD handout
consider diet trial

ES caught eating at 9:45 AM, likes the privacy of the blanket


12pm - bright, happy to see owners, wanting to get out of the cage.
advised discharge now, home with zofran, buprenorphine, synbiotic and mritazapine to use as needed
discussed IBD, recc food trial. 
consider biopsies in future.
recc recheck appt in ~1 month to reassess how she is and discuss ongoing plan further
did not discuss kidney disease today, as do not want to put her on a kidney diet at this stage, so is just a matter of monitoring.