C10000771 / invoice 10000

Verified: YESClient: RowanHistory: Recurrent episodes of colitis, 3-4 previous episodes. Current episode - green sticky mucoid faeces for several days, completely refused lunch yesterday (out of character), reduced appetite, flat demeanour, less playful than usual, shaking/shivering episodes last night (not done this for 12-18 months, previously associated with flare-ups). Currently on prednisolone 20mg PO SID x 3 days (usual flare protocol 20mg SID x 5 days max), cyclosporine every 2nd day. Ate only wet food for dinner yesterday then ate dry food at night. Straining to defecate, walks while defecating making assessment difficult. Sensitive to abdominal pressure. Owner gave NexGard Spectra early (usually 11th of month, gave yesterday) as precaution. Patchy fur loss progressing over last 2 years on head/ears. Lives with 2 year old child and another dog (Nala).Diet: HypoallergenicParasite Control: NexGard Spectra monthlyExam:Mentation: Flat, less energetic than usual, lying down more, less playfulTemp: 38.3?CCardio: HR = PR =104 bpm, no murmur or arrythmiaResp: RR = 20, normal BV soundsEyes: ClearEars: Patchy alopecia noted on head and earsTeeth: Gde 1/4, Other oral exam: NormalMM/CRT: pink/moist, CRT<2sAbdomen: Sensitive to palpation/pressure, gassySkin & Haircoat: Patchy alopecia on head and ears, progressing over 2 yearsMusculoskeletal: NormalLymph Nodes: NormalNeurologic: NormalUrogenital: NormalRectal: Loose faeces in rectum, no obvious blood or mucous noted on exam, sensitive during examOther problems found: NoneAssessment:Abdominal sensitivity, loose faeces on rectal exam, flat demeanour, reduced appetiteDDx: Eosinophilic colitis/ IBD flare upPlan:Treatment: - Continue prednisolone 20mg PO SID for additional 2 days (total 5 days)- Continue cyclosporine every 2nd day- Stepped up medication protocol discussed and dispensed metronidazole and fenbendazoleRecommendations & Client Comms: Monitor for bloody or mucoid faeces, monitor appetite and activity levels, continue current dietRecheck: Yes, as needed if condition does not improve or worsensNext step faecal PCR11/2 NCB MS - okay, just about the same, ate this morning. O just had neck sx so kept brief

Verified: YESHISTORYPresenting for: Canine patient presenting for medication review for IBD. Currently on cyclosporine and prednisolone for inflammatory bowel disease.Historical Conditions: - History of inflammatory bowel disease (IBD)- Previously diagnosed with Giardia infection- History of anxiety issuesDiet: - Royal Canin Hypoallergenic diet exclusively- Carrots as treats- Tolerates antlers as chewsV/D/C/S: - Recent episodes of mild diarrhoea and occasional coffee-coloured vomit- Previously had flare-ups when medication was reducedCurrent Meds: - Cyclosporine 100mg every other day- Prednisolone 10mg every other day- Previously attempted reduction to prednisolone 5mg every other day but experienced flare-ups- Previously on fluoxetine for anxiety but was weaned off as it wasn't making significant differenceLifestyle Risk Factors: - History of limited socialisation as a puppy due to illness at 18 months of age- Anxiety around other dogs and the postman- Anxiety worsened after moving from South AustraliaOther: - When experiencing GI flare-ups, treated with prednisolone 20mg daily for 3 days- Previously consulted with internal medicine specialists- Anxiety worse when owner walks with pram- Previously seen by behavioural consultant (Lisa)EXAMMentation: BARChest auscultation clear. COmfortable on abdo palpation.ASSESSMENTInflammatory Bowel Disease - Currently stable on cyclosporine 100mg and prednisolone 10mg every other dayAnxiety - Situational anxiety primarily with other dogs and strangers approaching the housePLANMedications/Treatments:- Continue current medication regimen: cyclosporine 100mg every other day and prednisolone 10mg every other day- Continue using prednisolone 20mg daily for 3 days during GI flare-upsAdditional Discussion:- Discussed contacting previous internal medicine specialist to confirm if current medication protocol is optimal- Discussed whether trough level testing for cyclosporine might be beneficial- Discussed potential anxiety medication options that would be compatible with cyclosporine if needed in futureClient Comms:- Will email previous specialist to confirm if current medication protocol is appropriate and if trough level testing is recommended13/11 No ncb as lucy to email clients re plan mc

Dx: Eosinophilic collitis/IBDPrednisolone 5mg every other day ongoing (owner has requested 20mg tablets).Increase to 20mg SID x 3 days during flare upsDispensed 20mg tablets x 25Atopica 100mg capsules x 1001 capsule every other day ongoingMed review due November 2025 (booked for mid November).Pred in meds drawer, atopica label printed for order.