C10002684 / invoice 10000

Reason: Y - Seizure, Lasted 5 Mins OTB MY/HS Dr Holly Sanders did consultHISTORY:Sunni presented following a 5-minute tonic-clonic seizure at home. The owner reports that their son dropped a small amount of salt (approximately a teaspoon) from pork he was cooking, which Sunni ingested from the floor. Within a minute, Sunni vomited twice and then proceeded to have a seizure. During the seizure, Sunni was described as being 'out of it' but with her eyes open, frothing at the mouth, shaking, and with limb rigidity. She also urinated and defecated. This episode is reported to be identical to a seizure that occurred six months ago.Since the last seizure, the owner notes a change in behaviour. Sunni has become more reactive and barks at noises, which began after she was attacked by another dog approximately one month after the first seizure.Sunni has been indoors for most of the day due to rain. There is no known access to other toxins.Current meds: noneProphylaxis: UTD vacc and FTWPre-existing conditions: History of a single seizure six months prior.Access to toxins eg. Rodenticide: noneTRIAGE:HR: 120RR: 24Temp: 38.7Mm: pink, moistCrt: <2 secondsMentation: BAREXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): EuhydratedCardiovascular: cardiac ausculation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, full neuro exam not performedMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain- Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFPROBLEM LIST:- Tonic-clonic seizure (5 minutes duration)- History of previous seizure (6 months ago)- Vomiting preceding seizureDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Differentials for seizures include intracranial causes (e.g., idiopathic epilepsy, brain tumour/mass) and extracranial/metabolic causes (e.g., toxin ingestion, hepatic dysfunction). Given Sunni's age and history, idiopathic epilepsy is a primary differential. Toxin-related seizure is less likely, including salt toxicity, as the amount ingested was minimal. The vomiting may have been a trigger or a coincidental event.Differentials for acute vomiting would include gastric and intestinal causes (eg. dietary indiscretion, foreign body, infectious, inflammatory, neoplastic, or toxic causes), abdominal disorders (eg pancreatic, hepatobillary, or renal disease or peritonitis) as well as metabolic and endocrine disease.DIAGNOSTICS:In-house blood analysis was declined.Hospitalisation for monitoring was declined.ASSESSMENT:Sunni presented for a 5-minute tonic-clonic seizure. This is the second seizure in six months. The duration of the seizure is significant, and initiation of anti-convulsant medication is indicated to control seizure activity. The primary differential is idiopathic epilepsy, which is a diagnosis of exclusion. Metabolic and toxic causes are less likely but blood testing may show an indication of organ disfunction. The owner has been counselled regarding the diagnostic process, including the option of advanced imaging (CT/MRI) versus empirical treatment and management. Recommended blood work and hospitalisation overnight to monitor for further seizures and institute phenobarbitone loading. Owner declined and elected to monitor at home and to proceed with medical management at this stage.TREATMENT:Phenobarbitone 30mg: Two tablets to be given every 12 hours starting tonight. (2mg/kg PO BID)Diazepam 5mg/ml: One syringe of 3mL to be given rectally or intranasally in the event of an active seizure. PLAN:Owner declined Sunni being admitted to hospital overnight for a seizure watch, administration of a loading dose of phenobarbitone, and supportive care. Owner declined in-house blood test to rule out underlying metabolic disease.Owner has been supplied with diazepam to be given rectally or intranasally in the event of an active seizure.They have also been supplied with phenomav to start tonight for long term seizure management. Steady state without loading dose is not reached for 6-8weeks. Follow-up blood tests in six months are recommended to monitor phenobarbitone levels and liver function.Recommended revisit with regular vet tomorrow to get a blood test done to check for metabolic causes.If Sunni has another seizure overnight, revisit is recommended. CLIENT COMMUNICATION:A detailed discussion was had with the owner regarding the potential causes of seizures in dogs, including intracranial (epilepsy, neoplasia) and extracranial (metabolic, toxins) causes. The diagnostic work-up, including blood tests and advanced imaging (CT/MRI), was explained. The nature of epilepsy as a diagnosis of exclusion was discussed.The pros and cons of two common anti-convulsant medications, Phenobarbitone (twice daily, requires blood level monitoring, slower to reach therapeutic levels unless loaded) and Keppra (three times daily, works faster, more expensive), were discussed. Side effects, such as initial sedation for 1-2 weeks, were also covered. The owner was informed that breakthrough seizures can still occur on medication, but the goal is to reduce their frequency and severity.An estimate for hospitalisation, diagnostics, and initial medications was provided, ranging from $2,000 to $2,500 for overnight care. The owner was also counselled on payment options, including insurance claims and third-party payment plans. The owner declined hospitalisation and blood work.The plan is to monitor Sunni at home overnight, and revisit with regular vet tomorrow for blood work. The owner was provided with discharge medications (Phenobarbitone and Diazepam) with clear instructions for administration.    Vital Signs