C10016394 / invoice 10000

11/03/2026 Reason: Ongoing d+

History:
On prokolin and chicken and rice as well as i/d only
Diarrhea has never went away. Very mucousy and sloppy
Keeps trying to go, making small spots of poo and there is red blood drops.
Got better on abx for 1 week longer than antibiotics lasted, then diarrhea slowly came back. 
Diarrhea first started in November, had vomiting at the same time initially (started after annual vaccinations); d+ is consistent, v+ is only occasional, last v+ 1 week ago 1 episode. Yellow bile with digested and undigested - whatever she just ate. 
Does not seem to be a fast eater and does not regularly run around after meals. In fact is normally a picky eater. 
O feels she had been good on chicken but once switched to kibble diarrhea comes right back

Vital Signs:
Temperature: 38.2 C
Heart Rate: 80  bpm 
Pulse rate:  80
Pulse character: strong and synchronous. 
Respiration Rate: 24. 
MM: pink, moist
CRT:   <1 sec

Dehydration assessment: Euhydrated MM moist no skin tent

PHYSICAL EXAMINATION:
Appearance: BAR; BCS 4/9
Eyes: nad. no redness, discharge, blepahrospasm. responds to visual stimulus
Ears: nad. no debris or inflammation
Nose: nad
Oral Cavity: mild plaque and gingivitis 
Cardiovascular: Auscultation no murmur detected ,pulse quality normal ,rhythm regular
Respiratory: RE normal , auscultation normal
Abdomen: soft and comfortable, no pain on deeper palpation, no obvious organomegaly or mass
Musculoskeletal:  ambulatory all 4 limbs
Neurological: appropriate mentation
Integument: free of ectoparasites or other skin lesion
Peripheral LNs:Normal size, symmetrical
Urogenital: not assessed
Rectal exam: not examined, no blood on thermometer

Assessment/Problem List:
1. Ongoing d+ (3 months+)
DDx: food sensitivity vs. dietary indiscretion vs. IBD vs. other

Hx of elevated ALT, mild hypoT

Treatment:
3ml blood collected from jugular to reassess parameters

Plan:
Awaiting tahp, o also brought in faecal sample for submission. 
Carafate 1/2 tab PO SID 1 hour prior to first meal of day, can be made into slurry
Prokolin 2ml PO BID (ran out of 30ml, only 60ml left, o will come and collect at end of week, still has a bit at home)
Trial hypoallergenic strictly

If tahp comes back with continued low T4 consider free T4 + TSH
If tahp NSF, and hypoallergenic not effective recommend abdo u/s.