C09998325 / invoice 10000

Reason: Recheck And Bloods Notes: XWXXXXXXXXXXXXXXXXXXXXXXXXXXXHistory:Whiskey is a 5 year 8 month old male neutered Australian Shepherd who is presenting today for a recheck of IE (tier II). He first presented to ARH Neurology on 11/07/23, where NEx was WNL. He was commenced on phenobarbitone 75mg PO BID, keppra 3/4 500mg PO TID and midazolam 1ml PRN IN if seizures occur. An increase in seizure frequency was seen in early 2024 (~3-4 seizures per month), although all events were 1 minute or less and singular generalised tonic clonic seizures. Assays were performed on 5/4/24 and displayed subclinical levels of potassium bromide at 8.3 (Canine bromide therapeutic range: 8.8 - 25.0 mmol/L) and adequate serum levels of Phenobarbital 150 umol/L (65-150). This drop is potassium bromide was theroised to be due to a change in diet from a low-salt diet (Lyka) to a higher salt diet of Hill's biome and Eureka. His potassium bromide was then increased to 400mg PO BID. Whiskey had a consultation with a veterinary behaviourist due to his anxiety, and fluoxetine was commenced at 10mg PO SID on 20/5/24. Whiskey's overall anxiety and sleep has improved on fluoxetine. Varying seizure frequency has been managed with medication see SM for details. 5/9/25 latest recheck, O reports current seizure frequency of about every 3 weeks. O increased KBr from 2.5 to 3 tabs PO BID about 2 months ago. After this increase Whiskey became very unsteady in his gait, and then had a bout of diarrhoea. O kept him on this higher dose for about 4 weeks, then reduced back to 2.5 tabs about 4 weeks ago because ataxia and sedation became intolerable. O feels increasing bromide is not possible for him - constantly falling, not able to manage up stairs, a lot more lethargic. O feels that seizure frequency is manageable at the moment, difficult to cope with at 2w frequency. Not himself for about 2 days after a seizure. Is generally a bit of a stressed dog. Otherwise hasn't changed. Is typically a little wobbly occasionally stumbling but not much. Seizure duration - about 1 min, consistent. Phenobarbital ( 44.4 mg/L) 191 umol/L (65-150). Bromide: 19.5 mmol/L. Increased Bromide 600mg.6/3/26 (today). Medications 6:15am. Food. Seizure history – Description: GTCDuration: SleepingTime of day: Majority occur in the afternoon or early morning Activity on onset: Resting/sleepingAutonomic signs: Urination, frothing at the mouthPre-ictal signs: Anxious and unsettledPost-ictal signs: Disorientation and ataxiaClusters: NoneInterictal period: 2-3wInterictal signs: NonePossible triggers: NoneToxin access: NoneOwner concerns today – Continued seizuresAppetite – Increased Diet – Hill’s Biome and Eureka dog food Water intake – Normal Urination – NormalDefecation – NormalVomiting/diarrhoea – NoneCoughing/sneezing – NoneActivity - 30mins walk (15min walk, 15mins ball chasing) AM, 60mins walk (20mins walk, 40mins ball chasing) PMEnergy levels – NormalWeight changes – NoneBehavioural changes – NonePrevious medical history – - Historically has had haematuria which was treated via castration Aug 2022 and course of antibiotics, and resolved. - Hip Dysplasia which does not currently affect his agility. - Heterozygous positive for MDR-1 Preventative medications – UTD with vaccinations. Stopped giving Nexguard Spectra from 18th March 2023Indoor / outdoor access Toxin exposure – None notedBIOP – 8 weeks oldCurrent medications: - PHB 125mg PO BID (1.25 x 100mg tabs)- KBr 500mg PO BID (2.5x 200mg tabs) - Keppra 500mg PO TID following seizure event until 24-48 hrs seizure free (500mg tabs)- Midazolam 1ml (1mg/ml) IN PRN at the time of seizure- Fluoxetine 30mg PO SID Examination findings: T:  NT                 MM: Pink and moistP:  100bpm        CRT: 2 secR:  24Demeanour: QAR, anxiousHydration: EuhydratedWeight: 27.2kg cf 26.1kgBCS: 5/9MCS: 3/3Cardiovascular: Normal rate and rhythm, no murmur detected, PSSRespiratory: Normal RE, RR and BVSEENT: WNLOral exam: WNLPeripheral LNs: All soft, symmetrical and normal sizedAbdomen: Soft and comfortable, no abnormalities notedIntegument: Full clear haircoat, no ectoparasites Musculoskeletal: Ambulatory with no pain or lameness detectedUrogenital: NSFRectal: NPNeurologic Exam Findings: Mentation/Demeanour - QARGait and posture – No significant findingsProprioception – PPR, RS and hopping intact in all limbsMotor function:1.Spinal reflexes - Intact2.Muscle bulk - Normal3.Muscle tone - NormalCranial nerves - IntactContinence - IntactSpinal hyperpathia – None noted Nociception - IntactOphthalmic exam - NPAdditional findings - NoneNeuroanatomical localisation: ForebrainProblem list:- SeizuresPotential causes:1. Idiopathic Epilepsy (IE)2. Structural (neoplasia, vascular, infectious, inflammatory)3. Reactive (metabolic vs toxin)Assessment: Whiskey's neurological examination is normal today. His seizure frequency and adverse effect profile is manageable at this stage, however further deterioration may not allow for appropriate QoL according to O.It is recommended today to reassess bloods to then determine further plan. Plan:Awaiting CBC, MBA, PHB, KBr - further plan to be determined from thereAddition of zonisamide may nee to be considered in the future    Vital Signs    Weight: 23.2;