C09991808 / invoice 10000

Reason: Seizure Watch & Liver EnzAppointment Notes: Overdue remindersWynstan – Seizure Summary (Past 24 Hours)Dog Details· Name: Wynstan· Age: 12· Weight: ~40 kg (Australian Bulldog)Medical History· First seizures occurred ~3 years ago.· Treated with phenobarbital.· Keppra (levetiracetam) used temporarily for ~4–6 weeks during initial stabilisation, then discontinued.· Maintained primarily on phenobarbital since.· Phenobarbital dose gradually reduced over the past 3 months due to elevated liver enzymes.Possible Seizure (Unconfirmed)· Between ~8:00 AM – 9:30 AM yesterday owner was not home, so a seizure cannot be ruled out.Confirmed Seizures· 1) ~10:30 AM – Duration ~45–60 seconds. Frothing at mouth, limb tremors, unconscious. Recovery took several minutes.· 2) ~2:00 PM – More violent seizure. Limbs contorting/stiffening. Tongue turned blue. Diazepam administered and seizure stopped almost immediately.· 3) ~9:00 PM – Occurred suddenly while standing then collapsed. Diazepam administered ~20–25 seconds after onset. Seizure stopped shortly after. Post-seizure: dazed ~5 minutes, went outside and passed stool, drank water and settled.· 4) ~1:00 AM – Duration ~20–30 seconds. Very small amount of diazepam administered (last available). Post-seizure: dazed but responsive, very lethargic, did not want to get off bed, recognised owner, took ice.· 5) ~4:25 AM – Duration ~1.5–2 minutes. No diazepam remaining. Recovery slower than earlier seizures. Stood slowly and walked outside, urinated and passed stool, panting ~15–20 minutes, then settled on cool tiles.Pattern Observed· Seizure times: 10:30 AM, 2:00 PM, 9:00 PM, 1:00 AM, 4:25 AM.· Spacing approximately 3–7 hours.· Wynstan recovered awareness between seizures.Medication Given· Phenobarbital: Morning dose yesterday, ~2:00 PM yesterday, ~7:30 PM yesterday, 6:00 AM this morning (given with ~100 g chicken).· Diazepam: Used during earlier seizures. Small amount used during 1:00 AM seizure. None remaining afterwards.Behaviour Between Seizures· Recognises owner.· Responds to voice and food cues.· Breathing normal and gums pink.· Able to stand (though shaky).· Ate chicken this morning with medication.· Drinking water / taking ice.· Able to urinate and defecate.· Sleeps or rests between seizures.Current Status (~6:00 AM)· Resting in bedroom doorway.· Breathing quiet and steady.· Responsive.· Morning phenobarbital dose given.Owner Concern· Cluster seizures following phenobarbital dose reduction over the past 3 months due to elevated liver enzyme concerns.Owner Goals / Requests· Primary goal is to re-establish seizure control by returning Wynstan’s medication to an effective therapeutic level.· Owner understands phenobarbital reduction was attempted due to liver enzymes but seizure control is the priority.· Request veterinary guidance on appropriate phenobarbital dose going forward and whether additional medication (e.g., Keppra) is recommended.· Request rescue medication (diazepam or similar) to keep at home for future seizures or cluster episodes.Plan: Admit today for seizure watch and bloods Treatment: IVC placedDiazepam dose IF NEEDED 4ml - 8ml IV Bloods taken for level 3 + pheno levelsTo increase pheno dose back to what it was and will do a script for keppra as wellPheno 100mg PO BID (2.5mg/kg BID) Keppra 1000mg x 1 tab PO q8hrs (25mg/kg)Bloods -Pheno 96.7 (therapeutic level) - was 98.4 in Aug 2024 ALP > 2000 (same as last 2 tests) ALT 139 (282 in Aug 2024) Have ordered midaz 3ml vials x 10 for owner to keep at home for seizures - to give 1.5ml intranasal when having a seizure, either need to show the owner how to open the glass vials and draw up midaz OR we can transfer the midaz into one larger glass brown bottle for owner to draw up when needed Called owner and discussed doin BID pheno and adding in keppra for the next several weeks, owner has a consult with MLO tomorrow so said can discuss with MLO what the plan is going forward with his medications Request for Supply of Prescription MedicationSupplier:Date:                            05/03/2026Client Name:              Mrs  Louise  Annetts                                      28a Breyley Road                                      CAMBRIDGE PARK NSW 2747Patient Name:          Wynston  Patient Number:       51886CASpecies:                    dogGender:                     Male DOB:                          31/01/2014Visit Number:            28480516For Schedule 8 scripts, the prescriber must rewrite all mandatory particulars in their own handwriting.Please supply the following to Mrs Annetts for the express purpose of treating WynstonRx:	…Keppra (Levetiracetam) ……………………………...........................................Mitte:	…1000mg x 120 tablets (2 bottles of 60 tablets) ……………………………............................................Directions:                   …Give one tablet orally every 8 hours ………………………………………………………….                                         …………….…..………………………………………….REPEATS: 6KEEP OUT OF REACH OF CHILDRENFOR ANIMAL TREATMENT ONLYNo. of Items: ……1…………………Vet Signature: ……………………………………….Vet Name: Dr Jess Choong NSWV11814    Vital Signs    Weight: 40.2;       BodyScore: 6;