C09994624 / invoice 10000

Reason: Still Has DiarrhoeaAppointment Notes: Special payment terms exist, Overdue remindersReason: Client Present: KarenNurse:HPP Blood Test - When was it last done?Vaccination Type: noIntestinal worming: milpro utdHeartworm Prevention:^^Flea Prevention: bravecto spot on utdTick control:^^Microchip: yes on fileInsurance and Healthy Pets Plus:Behaviour concerns:Current medications:Current Diet: cooked turkey mince + sweet potato__________________________________________________________________________Reason:chronic intermittent diarrhoea, present for over a monthhistory of inflammatory bowel disease (ibd) and colitispoor response to metronidazole, psyllium huskdiscussion regarding potential apoquel side effect vs food allergy vs underlying ibdHistory:presenting with chronic diarrhoea for over a monthhistory of intermittent soft-serve diarrhoea since puppyhoodowner reports finding faeces inside the house, indicating loss of bowel control, which is unusual as she is well toilet-trainedepisodes are characterised by straining, circling, and passing multiple small, mucoid, brown spots of diarrhoeaappetite is good, described as excited to eatprevious episodes managed with metronidazole, which provides temporary relief, but diarrhoea returns upon cessationpsyllium husk was added to diet on advice of dr lisa, which seemed to provide some improvementpast medical history includes reflux (allergic to losec), and a severe episode of acute haemorrhagic diarrhoea syndrome (hds) previously, requiring icu hospitalisation from boxing day to new year's eve the year before lastprevious investigations include an endoscopy with biopsies, though results were not recalled by ownerdiet: currently fed turkey and sweet potato; has previously been on prime 100 but developed an aversion; has also had cooked lamb minceno c+/s+/v+/d+ (other than the presenting diarrhoea)eddu: eating and drinking well, urination normal, defecation is diarrhoeicparasite control: not mentionedpre-existing conditions: inflammatory bowel disease, colitis, skin allergies, keratoconjunctivitis sicca (kcs), history of hds, refluxcurrent medications or supplements: apoquel, tacrolimus eye drops (optimmune/tacrolimus was implied by "saurus"), psyllium husk; previously on pro-kolin and a yeast supplement which will now be stoppedowner reports no other concerns todayExamination:Body Condition Score: 5/9GENERAL: bar, calm and friendly temperament, well-hydrated, mm pink and moist, crt <2sHEART: HR not recorded, regular heart sounds, no obvious murmurs or arrhythmias, strong and synchronous peripheral pulsesRESP: RR not recorded, auscultation feels 'a bit fluidy, scratchy', but no overt crackles or wheezes noted, normal effort and no obvious nasal dischargeEARS: external exam only - no discharge, no odour, no obvious inflammation or irritationEYES: bilateral mucoid discharge and pigmentary keratitis noted, consistent with kcs history; previous corrective surgery on one eye was unsuccessfulABDO: abdo soft and supple on palp, no palpable organomegaly, or masses, gut sounds described as 'gurgly'LYMPH NODES: no peripheral lymph node enlargement on palpORAL: mild plaque build-up and gingivitis observedMSK: good general conformation and ambulatory on all four limbs, patellas bilaterally firm, no hind dew claws, good range of motionINTEGUMENT: coat in good condition, hair is a bit thin on the frontal region, two small skin lumps noted on the trunk which owner reports may be decreasing in sizeUROGENITAL: no umbilical hernia, entire, vulva appears grossly normalAssessment:chronic relapsing colitis, likely a manifestation of underlying inflammatory bowel diseasedifferential diagnoses include dietary intolerance/allergy, adverse drug reaction (apoquel), or dysbiosisrecent rectal examination by dr danny revealed no polypsTreatment: prednisolone to be started at homestop apoquel and assess responsePlan:discussed the multifactorial nature of her chronic colitis, suspecting either an underlying inflammatory bowel disease flare-up, a food-related trigger, or a side effect of apoquelthe plan is to commence a tapering course of prednisolone to manage the inflammation and concurrently cease the apoquel to rule it out as a cause of the diarrhoeaadvised prednisolone will also manage her skin allergies while apoquel is withdrawncounselled owner on potential side effects of prednisolone including increased appetite and thirst, and the long-term risks such as cushing's syndrome if used for many months/years, but reassured that a short course (e.g., 6 weeks) is safeadvised to also cease pro-kolin and other supplementsif this regime is successful, the plan is to wean off prednisolone and introduce an alternative medication for skin allergies that is not apoqueldiscussed the potential benefit of hill's biome diet due to its prebiotic fibre content to help restore gut flora, as an alternative to a faecal transplant, but will hold off on dietary changes for now to assess response to medication change firstfollow-up if no improvement within a few days or if any concerns arise    Vital Signs    Weight: 11.9;