C10001609 / invoice 10000

Revisit reason:
History:
Since returning back onto biome, still having bloods in stools
Has been a problem since jan 2026
Medications:none
EDUF:normal
Mentation:BAR
BCS (0-5):      
HR: 100
RR:wnl
MM:       pm           
CRT:<2s
Temperature: ne due to demenour
Dental Stage:s1
Any additional findings:
Rectal nad no blood seen 

Assessment:
Strongly recc further investigation at this point- TAHP/GHP + ABDO U/S
Discussed delicate care trial as another option.
O keen for plan of further diagnostics

Treatment:
nil
On-going medications required: Y/N (use prescription tab for further supply):

Plan: book in abdo u/s with GHP /TAHP

Reason:  
History: 
Had blood in stools first noted 4 weeks ago and had revisits. Last 2-3 weeks it cleared up once started on biome/bland diet. O gradually went back to normal diet, was okay for a week but then noticed blood in stools last 2 days. No blood in defecations on walks however. No diarrhoea, not runny, formed stools.
Wife reports today a bit of blood in the first bit of stool. 
No V+
Still EDU normal, very bright and not lethargic.

Over the weekend has been restarted on bland chicken and biome leftover. 

Normal diet is 2 cups dry food BID - "be frank" dog food, has been put onto this 6-12 months ago. Salmon and sardine for large breed dogs
Has otherwise been well on that diet up until last few months. No other diet changes.
May have been some treat changes. But no treats over the weekend and last few weeks that could be contributing to symptoms today. 
 
Current medications: none

What Preventative health cover is being used and do you need to purchase any today? UTD, last given middle of Jan

Examine: 
Mentation: BAR - bouncy 
Body condition score: 6/9
MM:     PM           CRT: <2s
HR:       110         RR: panting
LN: wnl
Temperature:  39.31

Ocular: BAR
Oral/Dental stage: grade 1
Ears: nad, no discharge
Cardiovascular: no murmur or arrhythmia
Respiratory: normal lung sounds
Gastrointestinal: soft and comfortable
Integumentary & lumps (measurement, location): nad
Musculoskeletal: ambulatory, full exam not performed
Urogenital: nad
Neurological: BAR, full exam not performed
Rectal: stools in colon normal consistency, formed, no masses or strictures. No blood on glove post exam

Assessment: 
Mucous and blood in normal stools
- responded well to biome diet, possible dietary intolerance (other ddx: IBD, less likely parasitic/infectious given negative fecal PCR recently)

Discussed diet trial vs further investigation. 
Can stay on biome long term otherwise trial delicate care sensitive stomach diets (kangaroo vs ocean fish) if biome costs too high for client to persist long term
Recc to go back onto biome and bland diet until normal before trialing transition onto another diet

Further investigation would include TAHP and abdominal imaging (abdo US). Pending results may need biopsies etc

Treatment: 
Owner elected to perform diet trial. 
Will continue with biome until normal stools then trial delicate care.

Plan: 
Reassess if no improvement or begins to have inappetance, V+, lethargy etc 

On-going medications required: Y/N (use prescription tab for further supply):

Followup: 

Called O, faeces back to normal. no mucus, no blood. O happy with faeces. conveyed results. Plan - continue current diet for another week then slowly over several days can change onto normal food - o keen to transition given cost of biome.