C09999216 / invoice 10000

Weight (Kg):8.40
History:Presenting complaint
Checkup for coughing and a seizure that occurred yesterday.

History
- Almost 10-year-old Cavalier Cross Spaniel.
- Known history of esophageal strictures (post-balloon dilation), left-sided heart disease, urinary incontinence, and seizure and fractured right front leg
- Current medications: Levetiracetam 250mg BID, Nexium 10mg BID, Vetmedin 2.5mg twice daily, 4cyte
- Seizure occurred yesterday morning (05/03/2026) with a 10-minute postictal phase.
- Owner was reminded of a previous recommendation to increase Levetiracetam to 375mg TID and to possibly add Topiramate (client had forgotten seizure in Dec had occured)
- Owner is hesitant to add new anti-epileptic medications or use Phenobarbital.
- Owner reports coughing after eating; daughters report more frequent coughing not associated with meals.
- Owner reports exercise intolerance, slowing on walks, and increased panting.
- Resting respiratory rate at home is 26-30 breaths per minute.
- Owner reports perceived pain in the right forelimb since the seizure.
- Owner inquired about a dental procedure.
- Owner requested a new prescription for Tacrolimus.
- Client declined pre-consultation bloodwork, citing normal results in December 2025.

PEx:
BCS 5/9
BAR
MM PM, CRT <2
HR: 3/6 left apical systolic murmur, sinus rhythm?
Resp: normal bronchovesicular sounds, eupneic
Oral: 2-3/4
Eyes: Meibobian cyst L dorsal eyelid margin
Integ: no erythema
LN: within normal limits
Abdo: soft comfortable, no obvious organomegaly, no abnormalities detected
MSK: Crepitus palpated in both stifles and hocks. Resistant to hindlimb manipulation at the hips. Resistance to manipulation of right front

Assessment
- Seizures: Poorly controlled; likely cluster events. Owner hesitant regarding medication adjustments.
- Cardiac: Known left-sided heart disease. Clinical signs (cough, exercise intolerance, increased RRR) are suspicious for progression of cardiac disease vs. other
- Musculoskeletal: Suspected osteoarthritis based on clinical signs and crepitus and residual pain on right front leg
- Dental: Severe periodontal disease requiring intervention.

Treatment
- Levetiracetam dose to be increased.
- Cartrophen injections for osteoarthritis management; dose to be calculated and emailed.
- Panadol dose for analgesia to be emailed.
- Tacrolimus script provided.

Client communication
- Discussed seizure history and previous recommendations for medication adjustment.
- Owner is hesitant to add a second anti-epileptic medication at this time.
- Agreed to increase the dose of Levetiracetam.
- Strongly advised that an additional anti-epileptic will be necessary if another seizure occurs.
- Discussed that coughing, exercise intolerance, and increased respiratory rate could indicate worsening heart disease.
- Advised that a cardiology consultation is required before any dental procedure to assess anesthetic risk.
- Discussed findings of osteoarthritis and management options, discussed joint supplements, pentosan, and laser therapy (to start off with), Beransa and CBD oil to be considered later
- Recommended bloodwork, which was declined by the owner as client noted drinking more
- Will email Cartrophen and Panadol doses.

Plan
Increase Levetiracetam dose. Start Cartrophen injections (client has 250mg/mL bottle).
Client to monitor for further seizures, coughing, and changes in respiratory rate or effort.
Cardiology consultation recommended prior to any future anesthetic procedure

BH