C10010196 / invoice 10000

Reason: US +/-Bloodsest $800Intern: SNHistory:Epic presents today for bloodwork and reassessment of her chronic inflammatory enteropathy (eosinophilic and lymphoplasmacytic subtypes). She has not been seen by IM since June 2025. Historically, Epic has been fed exclusively Hills Biome and is managed on prednisolone and maropitant/ondansetron as required. She has previously received cobalamin injections from her regular vet. At her last recheck (7/1/26), Epic was well up until Christmas, when multiple vomiting episodes were observed - O suspected this was largely due to oveexcitement rather than nausea. O increased to pred 1/4 tablet SID (1.25mg) from EOD dosing from this time and no further V+ was observed. Stools were fine at home. Bloodwork showed a persistent eosinophilia suggesting poorly controlled eosinophilic enteropathy vs parasitism. Transition to R/C anallergenic was advised. If transition progressed well, O was advised to decrease prednisolone to 1.25mg PO SID from 2 weeks after complete transition.OR that Epic did well with introduction of RC Anallergenic and prednisolone was weaned from 2.5mg PO SID to 1.25mg PO SID with no relapse of signs. At recent further reduction to 1.25mg PO EOD, an episode of vomiting up undigested food was observed and malodourous diarrhoea passed. O reverted to feeding Hills Biome due to refusal of Anallergenic at home, and prednisolone dosage was increased back to 2.5mg PO SID. Today, OR that Epic was doing well up until last Wednesday and over the weekend, with progressive worsening in vomiting, lethargy and soft serve diarrhoea with small volume of blood produced. Marked improvement was noted on Sunday when O gave ondansetron, maropitant and prednisolone and Epic was able to keep her food down. Epic prefers the biome food over anallergenic, so I has been mixing the two together. Current Diet: R/C Anallergenic. Historically strictly Hills biome (mostly dry, occasional wet)Current Medications:- Prednisolone 2.5mg PO SID- Maropitant 8mg SID PO PRN- Ondansetron 2mg TID PO PRN - Cobalazorb (Cobalamin B12) PO SID Examination Findings:T:  37.1 C     MM: pink P:  152 bpm       CRT: 1-2sR:  36 bpmDemeanour: BAR, vocalHydration: euhydratedWeight: 4.33kg (-200g)Body Condition Score: 6/9Muscle Condition Score: 3/3Cardiovascular: WNLRespiratory: WNLAbdomen: WNLPeripheral LNs: WNLOcular: WNLEars: mild brown ceruminous discharge bilaterallyIntegument: WNLOral exam: g2/4 periodontal disease & 2" halitosis. No lesions in oral cavity. Musculoskeletal: WNLGait: WNLNeurological: mentation appropriate, full exam deferredRectal: NP, brown faeces on rectal thermometerLaboratory: PCV/TP: 42/69, mildly lipaemicVenous blood gas:pH 7.219 (7.277-7.409) L pC02 42.4 (32.7-44.7)K+  3.7mmol/L (3.6-4.9)Na+  155mmol/L (151-158Ca2+ 1.32mmol/L (1.12-1.32)Cl- 124mmol/L (113-121)Glu 7.2mmol/L (3.5-8.0) H Lac 1.3mmol/L (0-2)BE -10.5mmol/LHC03 15.4mmol/LUltrasound Report:Performed by AM Rose285090Today's ultrasound 10th March 2026 is compared to the US report dated 7th May 2024 and represents a 1 year 10-month re-evaluation.Ultrasound findingsAbdomenGastrointestinal tractSmall intestineThe majority of the findings today are located in the jejunum, with a segment in the jejunum which is mildly corrugated and has increased wall thickness (up to 3.5 mm; reference range 2-2.5mm). There are other segments of the jejunum with prominence of the muscularis layer and mild increase wall thickness (up to 3 mm; reference range 2-2.5mm). And several segments with normal ultrasound appearance. There is some segments of jejunum which contain ingesta being mild to moderately distended.The duodenum has normal layering with mild increase in wall thickness (up to 2.9 mm; reference range 2-2.5mm).As an overall observation, there is ingesta in the stomach, and segments of the small intestines which is more than expected for the history of fasting.The remainder of the abdominal structures are within normal limits including the liver, spleen, kidneys, urinary bladder, adrenal glands (left 2.9 mm; right 3.2 mm), pancreas, medial iliac lymph nodes and cranial mesenteric lymph nodes.The portions of the gastrointestinal tract examined are within normal limits. The stomach contains moderate amount of ingesta, and the portions of the gastric wall examined are normal thickness (2 mm; reference range 1.7-3.6mm). The remaining portion of the small intestine is the ileum which has normal layering and wall thickness (2 mm; reference range 2.5-3.3mm).The colon wall is within normal limits (2 mm; reference range 1.4-2.5mm).Ultrasound interpretation1. Small intestines: Predominantly jejunum and to a lesser degree duodenum: Changes consistent with the previous findings of inflammatory bowel disease. Consider also a component of delayed transit given the amount of ingesta identified in the stomach and some segments of the intestine.Assessment: Problem List: - Inflammatory bowel disease (IBD) (eosinophilic and lymphoplasmacytic)- Periodontal disease Abdominal ultrasound today demonstrates changes most consistent with those expected with Epic's known inflammatory bowel disease. There are no findings to suggest another process other than primary gastrointestinal disease for Epic's recent gastrointestinal signs at home. Ongoing administration of prednisolone at 2.5mg PO SID is advised for at least the next 3-4 weeks. The long term goal will be to taper and maintain prednisolone dosage at 1.25mg PO SID ongoing. Treatment:Continue:- Prednisolone 2.5mg PO SID- Maropitant 8mg SID PO PRN- Ondansetron 2mg TID PO PRN - Cobalazorb (Cobalamin B12) PO SID Plan:O to update via email in 3-4 weeksIf progressing well at home, aim to taper prednisolone to 1.25mg PO SID ongoing/long-term    Vital Signs