C09970589 / invoice 10000

Reason: SeizureAppointment Notes: Overdue remindersEMERGENCYReason: Appointment Notes: Referring vet:History: 1 week ago had his first seizure and screamed, owner gave meloxicam. Took him around 30mins to settle down again and eat etc.Yesterday he spent a lot of time with a hacking cough and brought up a bit of phlegm. Today has had another coughing fit and gave a loud scream and thrashed around a bit. He did lose consciousness during that time. He passed faeces during this unconsciousness.Has not been to a vet during this period at all, no seizures confirmed,His back legs are still wobbly now and he is not completely himself.Has meloxicam at home for ongoing severe OA of hips/HLsExamination:General demeanour: barTemperature: 38.0Cardiovascular: HR 104, 6/6 systolic HM, CRT 1-2s, mm pinkRespiratory: panting, difficult to hear lung sounds over panting and HMAbdomen: soft and comfortablyPeripheral LNs: wnlEyes/Ears: wnlIntegument: wnlOral exam: mmm pinkMusculoskeletal: marked crepitus and stiffness in hips and lumbar spineGait: slightly stiff but picks up wellNeurological: not assessedUrogenital: not assessedRectal exam: not performedInitial Assessment:  6/6 systolic HMCollapse episodesCoughingPrognosis: guardedDifferential Diagnosis: severe heart disease with secondary syncopal episodes vs seizures vs neoplasia vs unidentified arrhythmia vs heartworm vs many other causes....Initial Plan: options to Sieglinde:1) xrays under sedation for assess heart and lungs2) trial heart meds and diureticsShe has elected for 2) today as she is concerned about putting him under sedation for the xrays.Laboratory:Radiology:Prognosis:Treatment: TGH with cardisure and frusemideClient communication: explained cardiac disease and the secondary syncopal episodes. Is quite severe heart disease if already have collapse episodes, however meds will assist with thr progression and the coughing (fluid on the lungs). If good resposne to meds, can continue to have them dispensed.    Vital Signs    Weight: 5.5;