C09975267 / invoice 10000

Reason: Toxo And Neospora BloodsAppointment Notes: Overdue reminders  ------- Sms reply: YHISTORY:Winston presented for toxo and neospora bloods and discussion regarding ongoing seizure management and medication options. Owner expressed concerns about current treatment limitations and lifestyle considerations when travelling with Winston. Discussion included monitoring requirements and medication compliance challenges. No seizures or side effects with Keppra, but limited with dosing q8hrs. Will likely stay on keppra, but considering phenobarbitone. I feel greater risk of side effects - sedation, appetite, but also liver and monitoring of levelsCurrent meds: KeppraVaccination: UTDParasite Prevention: Not mentionedPre-existing conditions: Epilepsy with seizure historyAccess to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): okHydration status (%): okCardiovascular: NADRespiratory: NADNeurological: NADMusculoskeletal: NADGastrointestinal:Oral: normal, no mouth pain, dental score (1-4): not gradedAbdominal: Not mentionedRectal: not performedIntegument/Ears: NADLymph Nodes: NADEyes: NADDemeanour/Behaviour: nervous PROBLEM LIST:Ongoing seizure managementMedication compliance and monitoring considerationsTravel limitations affecting treatment optionsDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Epilepsy requiring ongoing anticonvulsant therapyDIAGNOSTICS:PCR testing discussed for toxoplasmosis and neospora. No estimate although O advised about $600. Could only do toxo IgM and neospora for this (IFA considered better)Antibody testing options discussed including IgM testingASSESSMENT:Winston requires ongoing seizure management. Extended release formulations discussed but not available in Australia and likely not suitable for smaller patients. Phenobarb an alternative Blood monitoring required for current medication levels.TREATMENT:Continue current keppra but discuss with EB when call with blood resultsBlood results to be reviewed by EBwhen availableTreatment plan to consider owner's travel requirements and lifestyle factorsPLAN:Review results and adjust treatment as neededConsider alternative medication options (phenobarb) based on owner preferences and lifestyle requirementsFollow-up consultation to discuss medication adjustmentsCLIENT COMMUNICATION:Discussed ongoing seizure management options including current keppra therapy and potential alternatives such as phenobarbitone. Explained monitoring requirements and lifestyle considerations affecting treatment choices. Owner understands need for regular blood monitoring and follow-up care. Treatment plan to be adjusted based on blood results and owner's preference ()bid vs tid dosing)    Vital Signs    HeartRate: 136;       DentalGrade: 1;       RespirationRate: 24;       CRT: 1s;       MMColour: pink;       BodyScore: 5;