C10014370 / invoice 10000

Reason: Check skin, diarrhoea
History:
Covered in stickfast fleas - All throughout the skin. Came in last week and nurse advised for topical tx. Has done advocate and they are almost all gone.
O plucked them and shaved, flea bombed the whole house as well
Still had some scabs embedded in skin still but MUCH better
Since this has had an upset stomach
 - moderate amounts of mucoid diarrhoea
 - 2x nights ago she woke up and had diarrhoea in the middle of the night
 - then had more diarrhoea the following morning
 - last night she was restless and had diarrhoea in the bath
 - this morning was acting strange, tried to go outside but then again had mustardy coloured diarrhoea with mucous again and a bit of blood
 - then came inside and vomited this morning
Ate dinner last night and managed to keep this down
Last night was also scavenging for food - in bin, around dinner table
Has not stopped eating this time, has been quite hungry
Energy levels this morning were a bit flatter and quieter
Diet - Sometimes gets steak, oats, egg and turmeric. Now she is on biscuits (supermarket, unsure of brand)
 - last week has possibly some food that is not normal for her (bacon, sausage maybe, kebab)
Ongoing medical conditions - None
Current medications - None
UTD deworming/ectoparasite – Y - advocate

Examine:
Mentation: BAR, friendly
BCS: 5.5/9
MM: pink/slightly tacky CRT: <2s
HR: 72                RR: pant 2+
Temp: 38.2
PLN: Submandibular, popliteal and prescap wnl
Eyes: OU WNL, no squinting or discharge, PLR symmetric
Oral: mild periodontal grade, G1/C1
Ears: nsf
Cardio: reg no murmur
Resp: nsf, no increase in effort or sounds
Abdo: 
 - mild cranial abdominal sensitivity, some tenderness
 - no obvious mass palpable or thickening
Integ: nsf
MSK: nsf, ambulatory x4, no obvious pain on palp
Urogenital: nsf, no discharge
Rectal: Not performed

Problem List:
1/ Mucoid large bowel diarrhoea with haematochezia
2/ Vomiting
3/ Stickfast fleas, resolving
Ddx: Primary GIT (inflammatory enteropathy, dietary indiscretion (Likely with hx), hypocobalaminaemia, FB (less likely), neoplasia (less likely), etc VS secondary GIT pancreatitis, metabolic disturbances, etc
A: Recommended bloods today - O declined and wants to trial conservative. INI aware bloods and imaging are next steps.
P: Psyllium husk 1-2 tsp BID 
    Paracetamol 125mg BID
    Pro-kolin 3mL BID

Follow-up:
Revisit INI for bloods and imaging

Reason: Courtesy phone call attempted nalvm and sms sent LH

Gaby - ttponalm @ 10.20, follow up sms sent
Good morning 
We`re checking in on Tiffy, following her recent visit at Vetwest. If you have any concerns, please call 08 9404 1133.  For info visit www.vetwest.com.au/follow-up (no reply SMS)