C10024479 / invoice 10000

Appointment Notes: recheck d+? blDoesn't seem to be related to particular food ingestion, environment.... Hydrotherapy No stagnant waterEats possum poo etc, but o's pretty vigilant with access to these thingsReason:Subjective: Appetite: last night didn't want to eat or this morning Thirst: normalUrination: normal Defecation:  can do normal poosVomiting: no Diarrhoea: on/off digestive issues 4 months.  Yellow watery. Increased frequency but has continence.Parasite control: possibly not up to dateDiet: chicken rice and veg. Current medications: lomotil since Tuesday, prokolinAssessment: Chronic sporadic D+. Not responding to usual tx (lomotil, prokolin, bland food). Inappetant 12 hrs.Prior abdo ultrasound 4 mths ago Rule out:Cobalamin deficiency - blood collected todayInfectious causes - collect 3 fecal samples to submit for testingDietary intolerance? Hasn't been ruled out - consider this if no diagnosis Plan:Vit B injectionOndansetron in case nausea causing inappetanceMirtazapine to use if neededAdd psyllium huskStop lomotil - used for 3 days already.  Need a break     Vital Signs    Weight: 12.2;       MMColour: Pink;       HeadEyes: Normal;       Nose: Normal;       Skin: Normal;       MusculoSkeletal: Normal (6 wks post laminectomy. recovering well );       Ears: Normal;       Neck: Normal;       LymphNodes: Normal;       Heart: Normal;       Lungs: Normal;       Abdomen: Normal (Relaxed and comfortable to palpate. Borborygmus );       RectalGenetalia: Abnormal (yellow liquid d+ );       Gingivitis: 0;       Calculus: 2;       Observation: Normal;       Temperature: 38.1;       HeartRate: 120;       BodyScore: 5;       DentalGrade: 2;       CRT: 1-2;       

    Vital Signs    

Appointment Reason: Check Up, Appointment Notes: checkup post spinal sx + arthritis injDoing really well recovering post spinal surgery. Having hydrotherapy with physio twice weekly. Currently walking around 20-25 minutes at a time.Eating, drinking and toileting normallyO has still noted some bulging of abdomen that she didnt previously.BARMouth grade 2 dental disease, o concerned about dental health, explained she has moderate calculus maxillary carnassials but dental rx is not urgent in her case so I would recommend delaying COHAT for at least another 3 months ie once spine fully healedHeart regularAbdomen comfortable and soft, no masses palpableTemp 38.2HL proprioception a little slow bilaterally but ambulates wellExplained if concerned about abdomen appearance recommend abdo US. O not keen at this stage so Quick AFAST performed standing, small bladder, no FF, no masses visible. Explained this was not a comprehensive abdo US but no masses visible. It may be that abdo muscles are a little weaker following pred admin a couple of months ago in addition to spinal sx, so may make abdomen appear different depending on bladder size and GI contents etcCartrophen booster given     Vital Signs    Weight: 12.2;