C09981282 / invoice 10000

H: Eating normally and drinking normally. Behaviour is normal.Owner concerns: in the last has been scratching ears, shaking head, has pinna down,  and and limping a bit on RHL but still manage to jump on bench Since started phenomav 7.5mg bid - no seizure S: Eyes: Normal  Ears: Ear canal and ear drum nad - more wax on left ear then right but very minimal, inhouse ear cytology- cocci and mallesezia  Nose: NormalMouth: NormalSkin and S/C: NormalMusculoskeletal: NormalThoracic Auscultation: NormalAbdominal Palpation: NormalNeuro: Unable to assess gait as cat would not walk, but does has reduce proprioception in RHL cf to LHL  O: HR 184, RR 28, MM pink, CRT 1-2sec, Pulses NormalA: Bilateral Otitis externaT: home on otomax drop sid for 10 days P: recheck next appt (already have appt with MG next week)  

Has been taking medication well and so far no more seizures.In the last couple of days has developed diarrhoea, and this morning vomited.Has eaten since the vomit.She feels he is perkier than he was prior to starting meds, no sedation noted.Exam: BARMm pink, crt 1 sec, gums moistSkin elasticity is reasonable.Thoracic ausc NAD, breathing pattern normalAbdominal palp is relaxed, no masses or apparent discomfort.Messy perineum - hygeine clip in consult.T 37.5Assessment: GIT upset post initiation of anti-seizure meds.Treatment: maropitant 1mg/kg scPlan: home with further cerenia if required for the next few days, pro-kolin paste for diarrhoea. If symptoms persisting will need review next week

Echo - patient temperament made exam challengingLA:Ao 1.3:1FS 46%LVWd up to 4.6mmRight side nadNo valvular issues on colour doppler, spectral doppler not performedNormal pleural and pericardial spacesDry lungsNo observed rhythm disturbancesA: Heart is unlikely to be the cause of the seizure activityP: Home today and start on phenomav 1/4 tablets BID, recheck in a month for phenobarbitone serum levels and reassess with MG.