DAMNIT-V COMBINED EVIDENCE SNAPSHOT v3
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PATIENT
-------
Name: Hustle
Owner: Hillian
Species: Dog
Breed: 
Sex: 
Desexed Status: Entire
Life Stage: Adult
Activity Level: Moderate
Current Weight kg: 14.00
Ideal Weight kg: 15.00
BCS: 4.00

CASE
----
Case Title: Reflux
Primary Complaint: Reflux , weight loss, skin irritation
Status: Open
Date Opened: 06/06/2026

CLINICAL NARRATIVE
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Last 3 months of 2025, Hustle was on 100% Barf as she had reflux previously when fed any kibble.
Xmas 2025 I introduced PetnPro kibble as I could not get her to maintain a good weight.... she was at least 1- 1.5 kgs too light.
She was looking the best she has in years by End of January, she was on 50% PetnPro with barf.
March she was in season 8th to 30th.
Around the 23rd March I realised she has some rash on her belly, groin area. It was red, crusty circular lesions, and was itchy.
Vet 15th April (Animal Wellness)
Many different causes possible, including hormonal.
The kibble was stopped at 1st April.
Barf continued 100% of diet.
Xiao Feng San started after vet visit, along with herbal cream and weekly washes in oatmeal shampoo and conditioner. Seemed to improve for a week, but by day 6 after wash she was very uncomfortable again.
The rash cleared from belly and groin and was then along the spine and tail from the mid lumbar area. Once that began to clear, it started on her sides and flank....now it is neck underarms and forward half nipples. It is very red and some scabs and crustiness to start, then the red goes and there are dry flakey roundish scabs all over the area.
Currently she seems the worst, there is lots of redness of the skin, chest and neck area.... some of her nipples have lesions around them, and there is some swelling, almost as if she's having a phantom pregnancy. The lesions are appearing as red round areas with the hair thinning and and coming away.
I didn't continue with the herbs once they were finished, as she had reflux with it and she has dropped down to 14kgs.
I am losing the battle for her atm, she is wearing shirts during the day to stop her scratching and I am using tissue salts to contract the itch..... it all helps but her skin is still deteriorating.
I have stopped all chicken as well, doesn't seem to have helped, and she is still too underweight.

INITIAL DIFFERENTIAL NOTES
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LOCAL / REGIONAL CLINICAL CONTEXT
---------------------------------
These are vet-maintained local or regional clinical context entries.
They are not diagnoses, rankings or priorities.

I - Infectious / Inflammatory
- Spirocerca lupi
Region / Locality: Queensland Mount Isa / North West Queensland
  RAC Target: Spirocerca lupi / oesophageal granuloma / nematode migration pattern
  Physical Confirmation: Thoracic radiographs, endoscopy, faecal testing where appropriate, assessment for oesophageal mass or granuloma
  Notes: Locally important in Mount Isa / North West Queensland. Include in canine vomiting, regurgitation, weight loss or coughing presentations.

CLINICAL INTAKE DOCUMENTS
-------------------------

DOCUMENT: History
Type: Clinical History
Source: 
Uploaded: 06/06/2026 18:22

Last 3 months of 2025, Hustle was on 100% Barf as she had reflux previously when fed any kibble.
Xmas 2025 I introduced PetnPro kibble as I could not get her to maintain a good weight.... she was at least 1- 1.5 kgs too light.
She was looking the best she has in years by End of January, she was on 50% PetnPro with barf.
March she was in season 8th to 30th.
Around the 23rd March I realised she has some rash on her belly, groin area. It was red, crusty circular lesions, and was itchy.
Vet 15th April (Animal Wellness)
Many different causes possible, including hormonal.
The kibble was stopped at 1st April.
Barf continued 100% of diet.
Xiao Feng San started after vet visit, along with herbal cream and weekly washes in oatmeal shampoo and conditioner. Seemed to improve for a week, but by day 6 after wash she was very uncomfortable again.
The rash cleared from belly and groin and was then along the spine and tail from the mid lumbar area. Once that began to clear, it started on her sides and flank....now it is neck underarms and forward half nipples. It is very red and some scabs and crustiness to start, then the red goes and there are dry flakey roundish scabs all over the area.
Currently she seems the worst, there is lots of redness of the skin, chest and neck area.... some of her nipples have lesions around them, and there is some swelling, almost as if she's having a phantom pregnancy. The lesions are appearing as red round areas with the hair thinning and and coming away.
I didn't continue with the herbs once they were finished, as she had reflux with it and she has dropped down to 14kgs.
I am losing the battle for her atm, she is wearing shirts during the day to stop her scratching and I am using tissue salts to contract the itch..... it all helps but her skin is still deteriorating.
I have stopped all chicken as well, doesn't seem to have helped, and she is still too underweight.

NUTRITION ASSESSMENTS
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Total nutrition assessments for this case: 0
No nutrition assessment added.

NUTRITION EVIDENCE SNAPSHOT
---------------------------
No nutrition assessment available for this case.

EVIDENCE INCLUDED
-----------------
Clinical intake documents: 1
Nutrition assessments: 0
RAC / Audiomixer documents: 0
Pathology / laboratory reports: 0
Imaging reports: 0
HTMA reports: 0
Microbiome reports: 0
Supplement reviews: 0

EVIDENCE PENDING / NOT YET ADDED
--------------------------------
- Food entries, treat entries, supplement entries
- RAC / Audiomixer DOCX reports
- Pathology / laboratory reports
- Imaging reports
- HTMA report if requested
- Microbiome report if requested
- Supplement review

EVIDENCE STATUS
---------------

Evidence Used In This Snapshot:
- Clinical Intake: Used
- Nutrition: Not available

Additional Evidence Available If Clinically Indicated:
- RAC / Audiomixer screening: may help prioritise which physical tests or evidence domains should be pursued next.
- Pathology / laboratory testing: available if clinical signs, risk assessment, or response to treatment justify testing.
- Imaging: available if obstruction, foreign body, mass, trauma or structural disease remains a concern.
- HTMA: available if mineral/toxic element patterning is clinically relevant.
- Microbiome: available if chronic gastrointestinal, immune, dermatological or inflammatory patterns require deeper investigation.

Clinical Context:
A veterinary assessment is commonly made using the evidence that is clinically justified and practically available. This section records what was used and what could be added later, without implying that every possible test is required for every patient.

EVIDENCE WEIGHTING ENGINE v1
----------------------------
Domain weights used in this snapshot:
- Imaging: 5
- Pathology / Laboratory: 5
- Clinical Examination: 4
- Clinical History / Intake: 4
- Nutrition: 3
- HTMA: 2
- Microbiome: 2
- RAC / Audiomixer: 1
- Supplement Review: 1

Current snapshot contains Clinical Intake and Nutrition evidence only. Imaging, pathology, HTMA, microbiome and RAC are pending.

DIFFERENTIAL PRIORITIES v2 - WEIGHTED
-------------------------------------

1. No rule-based differential generated
Weighted Evidence Score: 0
Weighted Confidence: Low
Evidence:
- [System +0] Insufficient structured evidence available.

DAMNIT-V EVIDENCE-CONDITIONED POSSIBILITY MAP v2
------------------------------------------------
All DAMNIT-V domains remain visible, but each domain is interpreted according to the evidence actually collected in this snapshot. Low-evidence domains are retained for completeness without being over-prioritised.

1. A - Allergic / Reactive
Evidence Score: 4
Evidence Strength: Low-Moderate
Evidence found in this snapshot:
- Skin / paw / rash / itching / licking evidence is present in the clinical narrative.
Possibilities supported by current evidence:
- Atopic dermatitis, contact hypersensitivity, allergic dermatitis or irritant dermatitis.
Possibilities not currently supported / missing evidence:
- No allergy testing, skin cytology, biopsy, RAC reactivity screen or challenge result is yet attached.
Suggested RAC screen if this domain remains clinically relevant:
- Current foods against allergic / reactive burden
- Owner-reactive foods
- Histamine / mast-cell pattern
- Atopy / environmental allergen pattern
- Contact irritant pattern
Suggested physical confirmation if justified:
- Skin cytology if lesions are active
- Controlled elimination / challenge logic if clinically appropriate
- Environmental and contact exposure review
- Secondary infection assessment if pruritus or lesions persist

2. I - Infectious / Inflammatory / Immune
Evidence Score: 3
Evidence Strength: Low-Moderate
Evidence found in this snapshot:
- Skin lesions, licking, redness or rash can involve secondary inflammatory or infectious processes.
Possibilities supported by current evidence:
- Secondary bacterial dermatitis, Malassezia dermatitis, inflammatory dermatitis or immune-mediated skin pattern.
Possibilities not currently supported / missing evidence:
- No cytology, culture, CBC, biopsy, pathology or RAC infection/inflammation screen is yet attached.
Suggested RAC screen if this domain remains clinically relevant:
- Bacterial burden
- Yeast / Malassezia burden
- Immune dysregulation
- Inflammatory cytokine / tissue inflammation pattern
- Barrier breakdown pattern
Suggested physical confirmation if justified:
- Skin cytology
- Tape prep / impression smear where lesions are active
- CBC / biochemistry if systemic signs are present
- Culture or biopsy if recurrent, severe or non-responsive

3. D - Degenerative / Structural
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No direct imaging or structural confirmation has been added to this snapshot.
Suggested RAC screen if this domain remains clinically relevant:
- Structural obstruction / restriction signal
- Regional tissue integrity
- Pain or mechanical stress localisation
Suggested physical confirmation if justified:
- Physical examination and palpation
- Imaging if structural disease is clinically suspected
- Serial monitoring if signs are mild or improving

4. M - Metabolic / Nutritional
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No pathology, endocrine testing, HTMA or complete micronutrient confirmation is currently attached.
Suggested RAC screen if this domain remains clinically relevant:
- Zinc / copper / selenium / vitamin A / vitamin E pattern
- Essential fatty acid sufficiency
- Liver / endocrine metabolic stress
- Energy balance and protein utilisation
Suggested physical confirmation if justified:
- Review unmatched diet items and incomplete micronutrient fields
- Pathology if systemic or endocrine signs are present
- HTMA if mineral/toxic patterning is clinically relevant
- Diet correction and longitudinal response tracking

5. N - Neoplastic / Nutrition
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No mass, imaging, pathology, cytology or RAC neoplasia evidence has been collected in this snapshot.
Suggested RAC screen if this domain remains clinically relevant:
- Mass / nodule signal if any lesion is palpable
- Mast cell / inflammatory nodule distinction
- N-Neoplasia versus N-Nutrition clarification where relevant
Suggested physical confirmation if justified:
- Clinical examination of any lump or lesion
- FNA / cytology if a discrete mass is present
- Biopsy or imaging only if clinically justified

6. T - Toxic / Traumatic
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No toxicology, exposure confirmation, trauma imaging or RAC toxic/trauma screen is currently attached.
Suggested RAC screen if this domain remains clinically relevant:
- Chemical / toxin burden
- Drug reaction burden
- Environmental irritant
- Trauma localisation
- Tick / envenomation pattern if regionally relevant
Suggested physical confirmation if justified:
- Exposure history
- Physical examination of affected region
- Pathology or toxicology only where clinically indicated
- Imaging if penetrating injury, foreign body or deeper trauma is suspected

7. V - Vascular / Neurological
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No neurological examination, imaging, blood pressure, coagulation or RAC vascular/neurological screen is currently attached.
Suggested RAC screen if this domain remains clinically relevant:
- Vestibular / neurological axis
- Autonomic dysregulation
- Vascular compromise
- Coagulation / perfusion pattern
Suggested physical confirmation if justified:
- Neurological examination if signs are present
- Blood pressure and perfusion assessment if clinically indicated
- Advanced imaging or referral only if justified by signs

SNAPSHOT INTERPRETATION NOTE
----------------------------
This section does not remove any DAMNIT-V domain. It prevents all domains being displayed as equally likely by separating evidence-supported possibilities from framework-completeness possibilities.

RAC-GUIDED NEXT EVIDENCE v1
---------------------------
RAC is treated here as a screening and prioritisation layer. A positive RAC signal does not replace physical diagnosis, but it can increase the justification for targeted physical testing when cost, risk, or uncertainty make broad testing difficult.

Suggested workflow:
1. Generate broad differential possibility map.
2. Run RAC screening against the most plausible branches.
3. Compare RAC positives with clinical history, nutrition, examination and owner observations.
4. Increase priority for physical confirmation where RAC and clinical evidence converge.
5. Record later confirmation and outcome so RAC predictions can be validated longitudinally.

INTERPRETIVE CAUTION
--------------------
This evidence snapshot is not a final diagnosis. It represents the evidence currently available at the time of generation. Later laboratory, imaging, HTMA, microbiome, RAC, nutrition, or supplement evidence may change the interpretation.