C10002860 / invoice 10000

Appointment Notes: Special payment terms exist, Overdue reminders  ------- Sms reply: Yes   ------- Sms reply: YesRecord Written by: Olivia Ritchie (DVM 4)Record Checked by: 4y10m MN labrador retriever presented for recheck of chronic inflammatory enteropathy after ongoing treatment with chlorambucil. Pertinent history: 22/06/2021: Intermittent, but persistent diarrhea episodes have been reported since pt was 2 months old. This patient was initially treated empirically for giardia/coccidiosis with 50mg/Kg fenbendazole for 5 days, 20mg/kg baycox for 3 days and 2mL prokolin BID. Faecal sample was sent off for  faecal PCR and analysis.25/06/2021: The faecal PCR positive for clostridium, giardia and campylobacter. Restarting fenbendazole (50mg/Kg) SID for 5 days, beginning erythromycin (10/mg) TID for 5 days and prokolin. Due to the pt not gaining weight, a gradual transition to puppy kibble from the boiled chicken and rice diet was recommended. 28/11/2024: work up of his chronic intermittent diarrhoea, incl. Cobalamin conc, abdominal ultrasound + cystocentesis and ACTH stim test. Began Hill’s gastrointestinal biome diet to address dysbiosis, supplementation with cobalamin (B12) and prednisolone (0.36mg/Kg) SID pending results. AUS suggestive of lacteal dilation.17/01/2025: Biochem showed elevated ALP and ALT, and low TT4 which could be due to the current prednisolone medication. Change to Royal Canin hypoallergenic diet, reduce prednisolone (0.18mg/Kg) SID and schedule an endoscopy and biopsy.22/01/2025: Endoscopy and biopsy were performed. This revealed the stomach had an extensive irregular cobblestone white nodule with red focal lesions at the centre. The duodenum had an extensive irregular white patch; more granular than normal. The colon has a smooth mucosa and looks normal.28/01/2025: Biopsy results revealed severe lymphoplasmacytic gastroenterocolitis. Change to low-fat diet, continue cobalazorb, prednisolone (2mg/Kg) SID and Chlorambucil (4-6mg/Kg) SID.27/03/2025: There was evidence of muscle wastage around face and PUPD are most likely steroid induced side effects. Otherwise, it seems the IBD has been managed well so far. Discussed with the client nutrition management for IBD and reduction in prednisolone dose. The owner opted to reduce the prednisolone dose from 30mg to 20mg SID.09/04/2025: Patient presented for acute onset of pigmenturia. Urine culture and sensitivity test was performed through VPDS, which revealed mild E. coli growth in the urine.17/04/2025: Cephalexin (22mg/Kg) antibiotic treatment began on 13/04/2025 for the treatment of the bacteriuria. Soft stools (luminous orange colour) were reported on 13/04/2025, however, cleared with prokolin administration. The patient is currently on day 5 of antibiotic treatment, however, the client reported significant polyuria and stranguria. There has been no haematuria/pigmenturia reported since beginning antibiotic treatment. Change abx to trimethoprim/sulfamethoxazole, TMS (18mg/Kg) over the long weekend and then recheck.01/05/2025: Patient received faecal microbiome transfaunation; 31g of donor faeces administered per rectum. Prednisolone 20mg (1 tablet) SID, Chlorambucil 4mg (2 tablets) SID, Prokolin enterogenic - 2 sachets SID, Prokolin 6ml BID.  08/05/2025: Decreased Prednisolone 20mg SID to 15mg SID.  13/05/2025: pt presented with polyuria, nocturia, smelly pungent urine, generalized alopecia, increased skin flaking. Urinalysis and culture and sensitivity test revealed bacterial cystitis, started TMS. Continue prep 10mg SID. chlorambucil 4mg SID, pro-kolin enterogenic 2 satchets SID. Start Dermoscent Essential 6 supplement - apply 1 pipette onto skin q2 weeks for 8 weeks.19/07/2025: uneventful FMT after completion of abx for UTI. Urinalysis showed quiet sediment.31/07/2025: good clinical improvement noted by the ox since transfaunation. No episode of Vomiting or Diarrhoea, good appetite and no polydipsia. 06/08/2025: pt presented for inflamed R ear and suspected aural haematoma (possibly due to pruritus induced self-trauma), anal gland irritation. To clean ears with otoflush SID. PMP Ear Suspension 1mL to each ear BID. Scheduled for surgically drain aural haematoma. Suggested apoquel and cytopoint which ox declined. 07/08/2025: R ear aural haematoma drained 27/08/2025: recheck with abdominal ultrasound and ear cytology. no obvious structural abnormalities or inflammation of the bladder, kidneys, or prostate can be appreciated. Ear cytology revealed mild yeast population bilaterally. Administer Osurnia into both ear and continue Chlorambucil 4mg SID PO.October 2025: last bloodwork performed, mildly increased CRP and mild non-regenerative anaemia, otherwise WNL. Chlorambucil reduced to 4 mg PO SID x5 days per week (5 on, 2 off). December 2025: brief episode of diarrhoea but Leon otherwise clinically well. Bloodwork held. 29/01/2026: Had profuse watery foul smelling diarrhoea for 2 weeks duration and mild weight loss, likely flare up of chronic inflammatory enteropathy. Updated history: Leon has been well since the last recheck, no diarrhoea, stools have been completely normal. EDUD normal. Leon has been brighter, increased energy levels and more interested in food. Leon has had no further signs of UTI, no PU/PD. Eyes are still producing discharge, owners are wiping them at home. Leon has not been bothered by his ears. Physical exam: Mentation: BARWeight: 33.4kgBCS: 6.5/9HR: 84RR: pantingPulse rate and quality: 84bpm strong and synchronous femoral pulsesTemperature:38.5Eyes: Mild mucopurulent ocular discharge bilaterally, mild conjuctivitis, no blepharospasm. Clear corneas and sclera. Ears: mild ceruminous discharge, no erythema or swelling, no pruritus noted during examinationNose: no discharge, NADMucous membranes: pigmented, pink, moist.CRT: < 2 seconds Appearance: BARIntegument: Coat good quality.Circulatory system: no murmur or arrhythmia auscultated. Normal heart sounds, strong femoral pulses.  Digestive: Abdomen soft and comfortable on palpation.Oral: mild tartar build up, no oral lesionsGenitourinary: external genitalia appears normalMusculoskeletal: no abnormal gait or posture, weight bearing on all four limbs. Full MSK exam not performedNeurological: normal gait and mentation. Neuro exam not performed.LNs: LNs WNL - Symmetrical submandibular lymph nodes, popliteal and pre scapular LNs.Problem list:- Increase in BCS and weight - 1.5% in 1 month- Chronic inflammatory enteropathyDiagnostic tests: - Biochemistry prolife A VPDS - awaiting results Results: - Biochemistry all WNLAssessment:- Chronic inflammatory enteropathy is well controlled, no weight loss or diarrhoea. - Albumin and CRP abnormalities have resolved. - Increase in weight is likely a result of stopping steroid use and increased feedingPlan:- Reduce Chlorambucil to 2 x 2mg tablets every other day.- Recheck CBC and biochemistry in 1 month to look for myelosuppression- Reduce food to 2 cups morning and night down from 2.5 morning and nightCurrent medications:- Chlorambucil 4mg every week day - drop down to every other day (NEW DOSE).- 3 fish oil capsules at night- Pro-kolin eterogenic 2 sachets at night in food    Vital Signs