C10021628 / invoice 10000

Reason: blood test

History: doing well overall
usually seizure q6months
had seizure Christmas but had another one last week, usual short episode
recent change in environment, with new born

Current medication: phenobarn 7:30am/pm

was on gaba which made him sedate

Examine:
Mentation: BAr - excited             BCS: 7/9

Assessment/Treatment/Plan: taken blood from R jugular for wellness + phenobarb
redisc once blood test returns, adjust dose as needed, update label and script then

Owner asked whether she can stop Gabapentin as not noticing any different , okay to stop 

Has been licking / biting front paws in the past 16 weeks after the birth of a child. 
Has been well otherwise. 
No other changes in behaviour. 
Has been well otherwise. 

Licking through the day + worse when baby cries. 

Last seizure episode around Christmas - has one episode roughly every 6 months - mild, minor episode for a couple of minutes but recovers quickly after the episode. 

BAR on presentation 

Front paws - mild hyperkeratosis but no inflammation / infection - O to file pad 
Mild swelling R front paw Lateral aspect (metacarpal region) - not painful / possible underlying OA? but no lameness / possible old injury / trauma? - no current clinical symptoms associated with it. 

Paw licking suspected to be anxiety with changes with a new born baby. 

Recommended to try Gabapentin 600 mg - 3/4 tablet bid / O to call JC with update in 3-4 weeks / if needed, can add trazodone

Repeat prescription for phenomav is ok - Phenomav 100 mg - 1 tablet bid. 

Blood test in 1-2 months - wellness + phenobarbitone level