C09973073 / invoice 10000

Reason: SeizureHISTORY:- Bizzy is a 10-year-old, almost 11, female desexed dog presented for investigation of seizure-like episodes.- Since the start of January, there have been five or six episodes. The episode today lasted approximately three to four minutes, which is longer than previous episodes that were around 30 seconds. This is the second episode this week.- During the episodes, her eyes dart from side to side. She appears scared and confused but remains conscious, though she has a glazed look. She tries to respond when called.- After today's episode, she was unsteady on her legs and demonstrated a lack of coordination, being unable to get a treat that was close to her mouth despite being able to smell it.- The owner moved house at the start of January and initially attributed the signs to stress, but Bizzy has since settled into the new home.- She has been sleeping more recently, but her appetite, thirst, and exercise levels remain normal. She is still interested in walks and toys.- There has been no circling behaviour, getting stuck in corners, personality changes, or loss of command recognition.- Past medical history includes anxiety, for which she takes fluoxetine. She has a sensitive stomach and a history of poor recovery from anaesthesia, requiring extended hospitalisation after dental procedures. She had ear infections when she was first rescued but has had no recent ear problems. The owner has had her since 2020, after she was rescued from Queensland at approximately 2.5 years of age.- There has been no recent vomiting, diarrhoea, coughing, bleeding, or discharge. No known exposure to toxins or human medications, although there was floor varnish used upstairs in the home.- Fluoxetine 20 mg.- No known allergies.EXAMINATION:HR:125RR: 24Temp: 38.4°CMM:pink CRT-2sMentation: Bright, alert, responsive, though stressedHydration status (%): euhydrated Body Condition Score: 5Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal: - Oral: normal, no mouth pain, dental score: - Abdominal: no detectable pain on abdominal palpation, normal gut sounds - Rectal: npUrinary: bladder size smallReproductive (incl ext genitalia): desexed, vulva normal anatomyIntegument/Ears: clean furcoat no evidence of otitis. Ears appear normal with no sensitivity on examination.Lymph Nodes: peripheral lymph nodes normal size/shape & not painfulEyes: Age-related lens changes noted. Pupils are responsive to light, constricting and dilating appropriately. Vision is present in both eyes.ASSESSMENT AND PLAN:1. Episodic neurological events- The clinical signs, particularly the eye movements (nystagmus) and unsteadiness without loss of consciousness or other motor activity, are more suggestive of vestibular system dysfunction than true seizures. The increasing frequency and duration of these episodes are concerning.- Differential diagnoses include geriatric vestibular disease, centravl vs peripheral. inner ear pathology (less likely given the lack of chronic ear issues), - Recommended further workup could include blood tests, Gold standard investigation would involve advanced imaging, such as an MRI of the brain, or a CT scan which may be available locally.- Management recommendations include monitoring for any progression of signs, such as circling, head pressing, a persistent head tilt, or changes in the direction of eye movements. The owner can also monitor for the ability to blink and see at home. If the condition progresses, a trial of steroids could be considered for their anti-inflammatory effects. If the episodes become prolonged, anti-nausea medication may be beneficial. If events progress to full seizures, seizure management medication would be indicated.- Discussed referral to a specialist for further evaluation and imaging.DIAGNOSTICS:none at this stage TREATMENT:none at this stage PLAN:- The owner will monitor Bizzy at home for any changes or progression of clinical signs.- The owner will consider a referral to a specialist for further investigation, including the possibility of a CT scan or MRI.- If episodes are prolonged, anti-nausea medication may be prescribed.- If the condition is thought to be inflammatory and progresses, a trial of steroids may be initiated.- If episodes progress to generalised seizures, anti-convulsant therapy will be considered.    Vital Signs    Weight: 1;       

Visit Vet: Dr Sara BaileyVisit Vet: Dr Sara Bailey-------------------- Fees Charged: --------------------Item Code: 196476 Item Name: Referral Patient Admission Qty: 1.000Item Code: 195693 Item Name: Trazodone In Hospital Qty: 1.000Item Code: 151217 Item Name: Hospitalisation - Level 2 Per  Qty: 1.000Item Code: 7256 Item Name: Buprenorphine 300Ug/mL per mL Qty: 1.280    Vital Signs    

Visit Vet: Dr Sara Baileynote details from 2024-04-09:Urination - On puppy padnote details from 2024-04-10:Trazodone 100mg - None leftnote details from 2024-04-09:REFERRING CLINIC: North Hobart Veterinary HospitalAES VET:  Sara Bailey REASON FOR REFERRAL: Ongoing d+ post-GA 7 days agoRELEVANT HISTORY ONLY: Today she has been more stable with less d+ and only small smears. Her perianal area is very irritated and as such we started her on some buprenorphine for pain. We ran bloods and which showed low normal leukocytes and normal electrolytes and have also added in metronide- which has helped int the past. She has remained on trazadone and we restarted her fluoxetine today also MEDICATION PLAN - WHEN LAST GIVEN & WHEN DUE NEXT:*Hartmann's 79 ml/hr*Ondansetron (8mg wafers) 1 wafer PO last given 1000,1800 - due 0200*Maropitant (10 mg/ml) 1.92 ml IV last given 1100 - due 1100 WED*Paracetamol (500 mg/50ml) 0.5 tablet PO last given 1000, 1700 - due 0200*Pro-Kolin 5 ml PO last given 1100 - due 2300*Trazadone (100 mg) 1.5 tablets PO last given 0900, 1800 - due 0200*Buprenorphine (300 ug/ml) 1.28 ml IV last given 1400 - due 0000*Metronidazole (200 mg) 1 tablet PO last given 1500 - due 0200*Fluoxetine 1.5 capsules PO last given 0900 - due 0900 WED*Loperamide (2 mg) 2 capsules PO last given 0900, 1700 - due 0200 Treatment plan for AES Hartmanns 79 ml/hr IVFT *Ondansetron (8 mg Wafer) TID 8 mg PO given at 6pm next due 2am Trazodone (100 mg) 150 mg TID PO given 6pm next due 2am Maropitant (10 mg/ml) 1.91 ml IV last given 11am next due 11am WED Paracetamol (500 mg) 250 mg PO TID given at 6pm and due at 2am Loperamide (2 mg capsules) TID 4 mg PO given at 6pm and due at 2am Pro-kolin (30 ml) 5 ml PO given this AM when eating midday and next due midnight Fluoxetine 30mg SID given 9.30am TUES and next due 9am WED Flamazine on the bottom Q3 hours- dabbing better than wiping Bupreneorpine 0.02mg/kg IV given at 4pm and reassess need for it by midnight Metronidazole 200mg BID PO given 3pm and due 2am tempt to feed with ID warmed up- ate when hand fed in at lunchtime Thank you in advance for the care of our patient. We look forward to continuing their care tomorrow morning or after the weekend. Please call one of our hospital directors if you are considering keeping this patient at AES.EXAMINATION:TIME: 1830Mentation: BARCardiovascular: No murmurs or arrythmias auscultated, MM pink CRT <2 secsRespiratory: Normal lung sounds all fields, no discharge from naresTemperature: Will not allow being takenWeight: Did not checkAbdo: Soft and comfortable, there is a small amount of faecal staining and some scalding present externallyMusculoskeletal: Rising and ambulating by four limbs, full ortho exam not conductedNeurological: Appropriate mentation and ambulation, full neurological exam not conductedEyes/Ears/Skin: Mild faecal scalding around the rectumUrogenital: NADLymph nodes: WNLHydration/volume status: Euhydrated, euvolemic PROBLEM LIST: Improving diarrhoeaInappetence ASSESSMENT: Patient is gradually improvingUnsure if inappetence is related to disease or is related to stress of hospitalization PLAN:  Continue with supportive care Return to North Hobart in the morning via owner transfer  Client communication and account update: Spoke to owners at time of transferConfirmed treatment plan for the night Owners really keen to try and take Bizzy homeVery hopeful that Bizzy can come home tomorrow as they are keen that she would be much happier at home Mode of transfer:  Owner transfer both ways-----------------------------------------------------------------------------------------------------SHIFT CHANGE: 2200-0800VET: Dr Trishul Vatakal DVMASSESSMENT:  diarrhea reducing just smears - 3 small smears not eating though but brighter  TREATMENT PLAN:  no change  -----------------------------------------------------------------------------------------------------TREATMENT SUMMARY Bizzy has been treated/monitored at Animal Emergency Service for ongoing diarrhoea which is gradually improving Please refer to *Smart Flow - Flowsheet* pdf for detailed clinical exam records and hospital notes. Treatments given & when next due are as follows:IV fluids at {__}*Ondansetron (8mg wafers) 1 wafer PO last given 0200 due 1000*Maropitant (10 mg/ml) 1.92 ml IV last given ** - due ***Paracetamol (500 mg/50ml) 0.5 tablet PO last given 0200 due 1400*Pro-Kolin 5 ml PO last given 2300 due 1100*Trazadone (100 mg) 1.5 tablets PO last given 0200 due 1000*Buprenorphine (300 ug/ml) 1.28 ml IV last given 2300 due 0800*Metronidazole (200 mg) 1 tablet PO last given 0200 due 1400*Fluoxetine 1.5 capsules PO last given 0900 next due 0900 WED *Loperamide (2 mg) 2 capsules PO last given 0200 due 0700  If you have any queries relating to this case, please call 1300 302 912Visit Vet: Dr Sara Baileynote details from 2024-04-09:Urination - On puppy padnote details from 2024-04-10:Trazodone 100mg - None leftnote details from 2024-04-09:REFERRING CLINIC: North Hobart Veterinary HospitalAES VET:  Sara Bailey REASON FOR REFERRAL: Ongoing d+ post-GA 7 days agoRELEVANT HISTORY ONLY: Today she has been more stable with less d+ and only small smears. Her perianal area is very irritated and as such we started her on some buprenorphine for pain. We ran bloods and which showed low normal leukocytes and normal electrolytes and have also added in metronide- which has helped int the past. She has remained on trazadone and we restarted her fluoxetine today also MEDICATION PLAN - WHEN LAST GIVEN & WHEN DUE NEXT:*Hartmann's 79 ml/hr*Ondansetron (8mg wafers) 1 wafer PO last given 1000,1800 - due 0200*Maropitant (10 mg/ml) 1.92 ml IV last given 1100 - due 1100 WED*Paracetamol (500 mg/50ml) 0.5 tablet PO last given 1000, 1700 - due 0200*Pro-Kolin 5 ml PO last given 1100 - due 2300*Trazadone (100 mg) 1.5 tablets PO last given 0900, 1800 - due 0200*Buprenorphine (300 ug/ml) 1.28 ml IV last given 1400 - due 0000*Metronidazole (200 mg) 1 tablet PO last given 1500 - due 0200*Fluoxetine 1.5 capsules PO last given 0900 - due 0900 WED*Loperamide (2 mg) 2 capsules PO last given 0900, 1700 - due 0200 Treatment plan for AES Hartmanns 79 ml/hr IVFT *Ondansetron (8 mg Wafer) TID 8 mg PO given at 6pm next due 2am Trazodone (100 mg) 150 mg TID PO given 6pm next due 2am Maropitant (10 mg/ml) 1.91 ml IV last given 11am next due 11am WED Paracetamol (500 mg) 250 mg PO TID given at 6pm and due at 2am Loperamide (2 mg capsules) TID 4 mg PO given at 6pm and due at 2am Pro-kolin (30 ml) 5 ml PO given this AM when eating midday and next due midnight Fluoxetine 30mg SID given 9.30am TUES and next due 9am WED Flamazine on the bottom Q3 hours- dabbing better than wiping Bupreneorpine 0.02mg/kg IV given at 4pm and reassess need for it by midnight Metronidazole 200mg BID PO given 3pm and due 2am tempt to feed with ID warmed up- ate when hand fed in at lunchtime Thank you in advance for the care of our patient. We look forward to continuing their care tomorrow morning or after the weekend. Please call one of our hospital directors if you are considering keeping this patient at AES.EXAMINATION:TIME: 1830Mentation: BARCardiovascular: No murmurs or arrythmias auscultated, MM pink CRT <2 secsRespiratory: Normal lung sounds all fields, no discharge from naresTemperature: Will not allow being takenWeight: Did not checkAbdo: Soft and comfortable, there is a small amount of faecal staining and some scalding present externallyMusculoskeletal: Rising and ambulating by four limbs, full ortho exam not conductedNeurological: Appropriate mentation and ambulation, full neurological exam not conductedEyes/Ears/Skin: Mild faecal scalding around the rectumUrogenital: NADLymph nodes: WNLHydration/volume status: Euhydrated, euvolemic PROBLEM LIST: Improving diarrhoeaInappetence ASSESSMENT: Patient is gradually improvingUnsure if inappetence is related to disease or is related to stress of hospitalization PLAN:  Continue with supportive care Return to North Hobart in the morning via owner transfer  Client communication and account update: Spoke to owners at time of transferConfirmed treatment plan for the night Owners really keen to try and take Bizzy homeVery hopeful that Bizzy can come home tomorrow as they are keen that she would be much happier at home Mode of transfer:  Owner transfer both ways-----------------------------------------------------------------------------------------------------SHIFT CHANGE: 2200-0800VET: Dr Trishul Vatakal DVMASSESSMENT:  diarrhea reducing just smears - 3 small smears not eating though but brighter  TREATMENT PLAN:  no change  -----------------------------------------------------------------------------------------------------TREATMENT SUMMARY Bizzy has been treated/monitored at Animal Emergency Service for ongoing diarrhoea which is gradually improving Please refer to *Smart Flow - Flowsheet* pdf for detailed clinical exam records and hospital notes. Treatments given & when next due are as follows:IV fluids at {__}*Ondansetron (8mg wafers) 1 wafer PO last given 0200 due 1000*Maropitant (10 mg/ml) 1.92 ml IV last given ** - due ***Paracetamol (500 mg/50ml) 0.5 tablet PO last given 0200 due 1400*Pro-Kolin 5 ml PO last given 2300 due 1100*Trazadone (100 mg) 1.5 tablets PO last given 0200 due 1000*Buprenorphine (300 ug/ml) 1.28 ml IV last given 2300 due 0800*Metronidazole (200 mg) 1 tablet PO last given 0200 due 1400*Fluoxetine 1.5 capsules PO last given 0900 next due 0900 WED *Loperamide (2 mg) 2 capsules PO last given 0200 due 0700  If you have any queries relating to this case, please call 1300 302 912-------------------- Fees Charged: --------------------Item Code: 151217 Item Name: Hospitalisation - Level 2 Per  Qty: 1.000Item Code: 196476 Item Name: Referral Patient Admission Qty: 1.000Item Code: 152193 Item Name: Fluids - Hartmanns 1Ltr Qty: 1.000    Vital Signs    Weight: 19.2;