C09996150 / invoice 10000

S:
  Todays  " seizure" 

 Nudge O leg  and was standing and     wobbly  She laid down .  was huffy and puffy  and  then  stood up and seemingly back to normal  but panting  and  over next 5 mins    returned to normal
 O  was preparing Midazolam(  didnt give ) And O thought she remained  responsive 
 This  is quite different to all previous seizure activity .

   Has been  normal   other this increase appetite since dose  increase 
HR 108 no murmur/arrhythmia - fp 
 Ha   been no episodes of hyporexia / vmit or diarrhoea 
  Given bloods were normal 4 weeks ago 
    categorise this ias episodic weaness 
  Suggest wait and see if recurs 
 Repeat  Phenolevel on a fasted  trough sample 

Nurse bloods done by Kalinda
Fasted phenobarbitol and standard profile with T4 as requested in previous consult notes.
Last fed at 7am this morning, blood taken at 5:30pm.
No seizures since seen last.

History:
Dog is currently on phenomav 100mg: 1/2 tab BID for seizures, last seizure in April 25
Also has midazolam 5mg/ml that O gave intra nasally through seizure. 
Taken to MASH. 
Given kepra 30mg TID for 48 hours. 
Given more midazolam and a atominiser to give intranasally. 

Dog is back to normal. 
Plan to run both Standard Profile for screening bloods and trough phenomav levels  - RV at 5.30 for fasted blood collection. 
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Lab:
CBC/biochem/T4 all wnl
Phenobarbital 88 umol/L ( 65 - 150 ) [ * ]
The most efficacious and safe therapeutic range reported for dogs is 65 - 150 umol/L, although efficacy can be seen at lower
concentrations.
Recommendations for when to assess serum Phenobarbital concentration:
- 2 and 6 weeks after commencement of therapy
- 2 weeks after a change in dose
- Every 6 months for long-term therapy
- If >2 seizure events occur between these times
Trough samples are best taken in the early morning, before dosing, in a fasted dog.

PLAN: Increase dose to phenomav 100mg: 3/4 tablet BID - will take 2-4 weeks to reach steady state - O to call if having seizure beyond then.