C10028243 / invoice 10000

Reason: Patient Was @ SASH Earlier This WeekAppointment Notes: Client called wondering if we can dispense more mirtazapine for Hennie? she's not eating! thank you, JHTelephone Call/ Text:: STO regarding Hennie. Went to SASH 11/3. Had abdo u/s and bloods repeated. Assessment at SASH is as below. Could trial appetite stimulant to improve compliance to diet trial. O reported that Hennie's diarrhoea is improving but she is not eating very much. Have probably only eaten about 100-150 g in last 24-48 hours. O feels that appettie stimulant was helpful to make her eat. Dispensed mirtazapine 15 mg x 3 tabs, 3.75 mg POBID as required. SASH report: AssessmentSee discharge noteDDX incl food responsive enteropathy, dysbiosis, fibre responsive enteropathy, less likely extra GI cause givenresults to date (liver functionality not assessed but no other markers on blood work to provide concern).Infectious enteropathy not excluded and a fenbendazole trial has been recommended to start; repeat faecal testingalso may be recommended.Options for management trials - likely to require sequential trialsFood: can commence a high fibre diet, potentially transition to novel protein (for Hennie, goat, venison, orcrocodile; latter very difficult to obtain currently).Additional of fibre also can be utilised. A novel protein or hydrolysed diet will be better choices if B12 concurrentlylow.Likely need to use appetite stimulants to improve compliance and assess efficacy as many diets have been tried forHennie with a short time frame used (either because of ongoing diarrhoea, reduced interest, or recurrence ofsymptoms during diet)Hennie may be a candidate for faecal microbial transplant if dietary trials are not effective.Colonoscopy discussed for definitive diagnosis and preferable before consider escalation to medical management(tylosin, budesonide, pred) with her age/signalment.    Vital Signs