C09985358 / invoice 10000

Reason: 2 Seizures Last 24 Hours, Only 10-15 SecondsAppointment Notes: Special payment terms exist, Overdue remindersHistory: Presenting for 2 seizures in last 4-5 days Brought in by daughter, who is a nurse- first seizure in Sep last year. Bloods showed borderline anaemia, borderline neutrophilia, mild azotaemia (urea 11, creat 160) and SDMA increase (16), moderate ALP increase (530), mild ALT increase (100), marked lipase increase. Was on metronidazole at time, query if seizure due to adverse effect or other.- each seizure in last few days was only 10-15 seconds long but were grand mal seizures. Very short pre-ictal phase, unsteady, vomit and then immediately seizes and urinates within a minute- post ictal only for 30 mins- last seizure yesterday 6pm, the one before was the day before at midday Overall QOL- more wobbly in hindlimbs, criss crossing in hindlimbs, drags feet sometimes. But can still get up a hill leading to home and mobility is not too bad. - occaisonal accidents but not increasing in frequency- sundowning, restless for an hour around sunset but settles within an hour- otherwise eats well, bright - OA seems well managed, no signs of pain or panting on gabapentin and Beransa. Stopped panadol and NSAID due to diarrhoea- history of pancreatitis so in low fat diet, but no issues since the last episode- lost 2kg in last 3 months despite good appetiteMedications: stilboestrol, beransa, gabapentinDue for Beransa tomorrow Examine: BAR, good awareness, calm and alertEyes - mild lens opacity onlyEars - NAD Oral - pink MM, CRT <2 sec. Grade 2/4 dental disease only Cardiac - no murmur or arrhythmia. HR 120, strong pulesResp - RR 20, normal bvs sounds bilaterally Abdo palp - no palpable massesMSK - ambulatory x4 but severe general cachexia. Skin - NADNeuro - cranial nerve exam WNL. Mild ataxia and delayed CP hindlimbs, dragging dorsal aspect of feet when walking. No neck pain LN - WNL peripherally BCS - 2/9 Assessment: Seizures - 2 in last week. Usually meets threshold to start AED, but given seizures are so short and pre/post-ictal phases so mild, recommend further monitoring before starting long term AED due to comorbidities and potential adverse effects incl liver effects etc. Cause likely intracranial. Would require advanced imaging for diagnosis though unlikely to change her prognosis and treatment options unlikely. CKD Hepatopathy QOL appears quite adequate at her age - no severe dementia, mobility impaired but not poor, OA pain well-managed. Weight loss is most concerning for underlying insidious or metabolic disease. Offered investigation (bloods) but declined as will not change her prognosis or management regardless. Treatment:Beransa 10mg SQPlan:Monitor for further seizures - if any in next few weeks, start phenomav. Can dispense over counter, but need to call/write notes regarding expected side effects. If any severe or prolonged seizures, recommend revisit or present to ECC for immediate AED Monitor weight loss and QOL - if weight loss progresses and seizures continue, recommend considering compassionate euthanasia at that point.    Vital Signs    Weight: 12.9;