C10030439 / invoice 10000

REASON: Abnormal gait, weak in hind limbs, licking legsHISTORY:- Seizures well controlled on current meds (pheno 15mg PO BID, Keppra, 125mg PO BID - o says not possible to do TID)- No seizures since last visit, sleeping more calmly- Mood improved, less grumpy- Can be handled/held without growling- Recent onset abnormal gait - 1 week- Walking with a strange gait and struggling to jump up onto furniture, requires a few attempts to get up- Excessive licking left medial hock causing erythema and alopecia- Running normally when playing with other cat- Recent change to weight loss diet, has lost 400gEXAMINATION:BAR, MM pink, moist, CRT < 2 secBody Condition Score: 7/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, no murmur/arrhythmia, pulse pressures normal and synchronousRespiratory: thoracic auscultation normal BV sounds bilaterally, respiratory effort and rate normalNeurological: normal CN & CPs, menace, PLR normal, no dragging limbs, strange behaviour in consult, laying on her side, staring up at the roof, circling her head around like she's following a fly (common behaviour for her at home)Musculoskeletal: no spinal pain, hind limb cow-hock stance, normal ROM but does vocalise with any palpation and manipulation of HL'sGastrointestinal:- Oral: no oral lesions, dental score (1-4): grade 0- Abdominal: soft, comfortable, no abnormalities on palpation- Rectal: not performedUrinary/Repro: NSFIntegument/Ears: 1cm patch erythema & alopecia left medial hockLymph Nodes: all <1cm, soft & symmetricalEyes: eyes open/comfortableASSESSMENT:- Seizure disorder - well managed- Altered gait- Licking left medial hock- ddx pain (trauma), vs neuropathic pain vs other neurological disorderPLAN:- Treatment: Pregabalin capsules morning and night for 2/52 trial, can open capsule and sprinkle on food, adjust dose if excessive sedation occurs- Follow-up: Update in 1/52 on medication response, monitor mobility and licking behaviour, vaccines next month- Client Communication: Discussed possible nerve pain causing abnormal gait and licking, pregabalin can help nerve pain    Vital Signs    Weight: 5.79;       HeartRate: 180;       Temperature: 37.1;       

Reason: Blood TestAppointment Notes: Booked Online: 23/01/2026 11:28:58 AMBooking Type: Health CheckBooking Notes: Hello , i would like to take an appointement for a blood test for check the level of phenobarbitone and also speak with the vet if we need to increase the amount du to the cat weight .Kind regard GGOwner Name: GUILLAUME GARCIAOwner Email: siaukss@gmail.comOwner Mobile Number: 0452624180Pet Name: MochaPet Species: CatWeb BookingClient name: GARCIAContact number: 0452624180Email address: siaukss@gmail.comPatient name: MochaSubjective:Cluster seizures. Reports approximately six seizures in a day, occurring once or twice.Episodes are less than one minute, described as focal seizures during sleep. Last night, episodes occurred at 1 am, 3 am, and 5-6 am. Post-ictal phase includes apparent disorientation/transient blindness and distress. No vomiting reported.Currently on phenobarbitone, half a tablet twice daily. Owner weighs tablets to ensure consistent dosing (0.45-0.5). Head can feel hot at times. Requires bathing every ten days due to odour from seizure based incontinence.Administered at 9:45 am and 9:45 pm without food.Objective:Still eating and drinking normally.No physical examination findings reported in this consultation.Blood tests for pheno have been performed, awaiting results.6.1kgAssessment & Plan:1. Seizures / EpilepsyAssessment: Breakthrough cluster seizures despite phenobarbitone therapy.Recommended diagnostic tests: Awaiting results of recent blood tests. Owner discussed cost of further testing (approx. $7,000 acc to o) for MRI and extended hospital stay, which is not currently covered by insurance.Treatment plan: ER clinician at SASH recommendation is to add an adjunctive anti-seizure medication. Commencing levetiracetam (Keppra) 250 mg tablets. Prescribed half a tablet (125 mg, approx. 20 mg/kg) to be given three times a day (every 8 hours) until advised otherwise based on pheno levelsFollow-up care: Continue current medications. Monitor seizure frequency, duration, and severity.Additional Notes:Owner education: Discussed the post-ictal phase and that apparent blindness is likely due to neurological recovery rather than true vision loss. Discussed the plan to add Keppra temporarily to control seizures while awaiting blood results. Advised that a TID (three times daily) schedule is ideal, but BID (twice daily) is better than none if TID is not manageable. Tablet form chosen over liquid for ease of administration. Owner expressed concerns about adding another medication and potential liver side effects. Discussed prognosis and the goal to stabilise Mocha for a good quality of life. Provided script for levetiracetam.Owner concerns addressed: Owner expressed concern about Mocha's suffering during unstable periods. Financial concerns regarding extensive diagnostic testing were also discussed.--- 28/01/2026 17:49:49 KB5:Laboratory: Idexx Pheno levels = 137umol/L--- 29/01/2026 11:52:30 AM EP1:Examinations - Resolved - The owner reported no issues    Vital Signs    Weight: 6.1;       

History: Examination: Laboratory: Assessment: Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:    Vital Signs