C10011549 / invoice 10000

BIB: Charlotte

HISTORY
- Presenting for: Gastro again.  
- Pertinent history:
   - Last seen 06/01/26 for mucoid D+. Faecal analysis:  - PCR: 
   - CPA positive + high range CPA alpha toxin
   - CPE positive + high range CPE enterotoxin  and so put on metronidazole trial
   - Heart murmur
   - 
- DID METRONIDAZOLE STOP D+ LAST TIME?     Yes think so, but then changed his food. 
- Diet change: Was on BARF. Trying to change to soak it and barley, carrot etc in it.  Put cooked meat with it. All cooked. 
- Thursday 5 days ago, and many piles of D+
- Then it didnt seem to be much, then loose, then half done chicken and rice and thought he was ok
- Today: started off Ok and then progressed to big loose D+
- Around middle February middle Anglesea he was eating Fertiliser at Anglesea. Mustard 3 teapsoons to make him throw up - brought up all fertiliser quickly with mustard in it. Seemed ok the next day. 
- Owner concerns:
   - x
- Appetite -  Still eating well 
- Energy - still good. Went for long walk on Saturday, 5km and 1km PM.  Seemed good
- Vomiting- no
- Regular diet:
- Unusual foods/bones - diet change to see above
- Current medications:
   - Antinol

PHYSICAL EXAM

- BAR
- BCS 4.5/9
- Left submandibular LN larger than RHS, 
- Gr 1 periodontal disease
- MM Pink, moist, CRT <2
- HR 100bpm, Heart murmur remains
- Temperature normal 38.5
- Abdominal palpation: diffusely tense, no obvious mass/FB

ASSESSMENT

- Diarrhoea last 5 daysd
- Had diarrhoea earlier in the year, possible CPA / CPEA still present but DID resolve 100% after metro last time
- Heart murmur 
- No recent bloods

PLAN

- Prokiolin 5ml PO BID 5 days
- Continue bland idet only: chicken, rice, sweet potato
- Consider i/d diet or Biome in future


TAHP to lab
  - 0431865248 (Charlo.tte with results.  Expect them in 48 hours
  - hold off cortisol today
  - Consider baseline 

Next step:
- Consider cortisol
- Consider i/d diet or Biome 
- INI consider metro trial again given last results

doing much better 
BAR and eddu NAD 

O has no concerns was currently on a walk while called 

Charlotte called:

down at anglesea and bertie got into neighbor's garden and ate fertaliser 
gave him 3 tablespoons of mustard to v+
v+ straight after everything up

bertie seems well in himself
advised to feed him a bland diet for a couple days 
us to call on friday to check in too