C10003840 / invoice 10000

Reason: New Client, Moved To Area NZAppointment Notes: Health check and talking about Gastro issuesHistory:Presenting for: Ruby, a 19-month-old female spayed spoodle, presented for ongoing intermittent diarrhoea with mucus and blood, seeking preventive management rather than reactive treatment.Historical Conditions:- Left-sided otitis externa with secondary infection (February 2026)- IBD with intermittent flare-ups causing diarrhoea- Previous treatment for Giardia with fenbendazole (January 2026)- Faecal float showed no parasites but clostridial bacteria present- Desexed at Lane Cove (27/03/25)- C7 vaccination December 2025, due December 2026- Previously tested for Addison's disease with basic blood profile . ACTH stim test not run Diet:- Currently SPD chicken and rice - Owner considering adding kibble for micronutrients- Previously on salmon-based diet as puppy with no issues- On psyllium husk supplementationV/D/C/S:- Intermittent episodes of projectile diarrhoea followed by mucoid, bloody stools- Episodes last 1-2 days then resolve, recurring every few weeks- Large volume watery diarrhoea initially, followed by small frequent mucoid stools with blood- Episodes appear uncontrollable with urgencyCurrent Meds:- NexGard Spectra for flea, tick and heartworm prevention- Drontal for worming- Psyllium husk supplementation- Pro-Kolin used previously (ineffective)Lifestyle Risk Factors:- Attends dog parks where episodes seem to correlate with visits- Drinks from communal water sources at parks- Scavenges and chews on various objects- Reports of rats seen in park guttersOther:- Weight loss occurred during severe episodes but generally maintains weight- Episodes often follow dog park visits by 2-3 days- Owner has moved residence since previous severe episodesExamination:Mentation: BARBehavioural: Anxious and stressed during examination due to previous negative veterinary experiences involving blood collection and rectal examinations. Required calming pheromone spray and muzzle for safe handling. Accepted small treats during examination.Abdominal: Examination limited due to patient stress and anxiety, unable to complete thorough palpationAssessment:Chronic intermittent large bowel diarrhoea with small bowel component - DDx: dietary IBD, recurrent Giardia infection, bacterial overgrowth, atypical Addison's disease. Pattern suggests initial small intestinal involvement (projectile watery diarrhoea) followed by colitis (mucoid bloody stools). Common condition in spoodles.Plan:Diagnostics:- Faecal parasite examination recommended using cumulative samples from multiple abnormal stools over 1-2 days to increase detection sensitivity for Giardia and other parasites- ACTH stimulation test discussed for atypical Addison's disease if dietary trial unsuccessfulNew Meds/Tx:- Trazodone discussed as pre-visit anxiolytic to be given 2 hours before future appointments to reduce stress and allow proper examinationDiet Recs:- Trial Hills Anallergenic diet (hydrolysed protein from bird feathers) starting with 3kg bag ($114 with money-back guarantee if unsuccessful)- Gradual transition over 10 days: start 10% new diet/90% current diet, increase by 10% daily- Strict dietary trial for 6 weeks with no treats or other food sources- If successful, can systematically reintroduce single proteins to identify allergensAdditional Discussion:- Explained pathophysiology of small vs large bowel diarrhoea and IBD in spoodles- Discussed importance of maintaining worming schedule- Basket muzzle training at home recommended for future examinations- If dietary trial fails, endoscopic biopsies or steroid therapy may be considered- Steroids would interfere with biopsy results if used first- Microchip registration completed in owner's nameClient Comms:- Photo documentation of abnormal stools recommended for better characterisation- Follow-up in 6 weeks if no episodes occur during dietary trial- Contact if severe episodes persist despite dietary management- Avoid dog parks and communal water sources during trial period--- 05/03/2026 09:50:12 CSR:New Client Call - Resolved - tried to call re: new client recall, no answer, vm left - BN    Vital Signs    Weight: 9.4;       

--- 27/02/2026 09:37:17 NZ:HX requested from Village Vet Killara and Dr Paw Lane Cove NZWas a walk in for food and turned into a new client as she moved to the area recently NZ--- 27/02/2026 10:52:55 NZ:Hx from Dr Paw Lane Cove attached NZ--- 27/02/2026 17:08:34 CSR:Hx attached from Pymble Vets KA    Vital Signs