C10030501 / invoice 10000

Reason: L3: Seizure @10pmHISTORY:- Around 10pm, Eden was unconscious (owner believed her to be asleep), and she then urinated herself, and arched her back as if having a seizure, and was non-responsive. - Seizure lasted a couple of minutes, per owner's estimation- Following the seizure, Eden was acting odd and moved away from the owner, sat in the corner leaning against an object, and was staring into space- She was steadily becoming more like herself over several hours while awaiting consult at PVE, but was still quieter than usual.- Otherwise well- Known to be stressed at the vetCurrent meds: NilProphylaxis: Up to datePre-existing conditions: - Gastrointestinal foreign body around 6 months old, recovered- Head injury in 2023 with suspected mild concussion, resolvedAccess to toxins eg. Rodenticide: Nil known, but went to a different park than usual todayTRIAGE:HR: 100RR: 40 (anxious)Temp: 38.2 C Mm: pink/moistCrt: 1sMentation: BAR, anxiousPain Scale (0-4): 0Hydration status (%): no deficitsEXAMINATION:Body Condition Score: 5/9Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  1- Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: not performed due to anxious temperamentUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: peripheral lymph nodes normalEyes: NSFPROBLEM LIST:1. SeizureDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:1. Intracranial (infection vs inflammation vs neoplasia vs idiopathic/epilepsy) vs extracranial (metabolic/endocrine vs intoxication) DIAGNOSTIC/MANAGEMENT PLAN:CBC, biochemistry, seizure serologyDIAGNOSTICS:Seizure panel (cbc, biochemistry, and seizure serology) submitted to NovavetASSESSMENT:Eden presented for having a seizure. She was well on examination with no obvious cause of seizures identified. Given her signalment, epilepsy is possible but a diagnosis of exclusion. She is not yet started on antiepileptic medications, as they may not be required depending on frequency of seizures moving forward. A seizure panel has been sent to Novavet for initial testing of common causes of seizures. TREATMENT:Gabapentin 600 mg 1hr prior to blood collection for anxiety at the vetPLAN:Discharged home to owner's careMidazolam 0.2 mg/kg intranasal in the event of a seizureGabapentin 600 mg PO the night before, and 2 hrs prior to vet recheckAwait seizure serology results from NovavetCLIENT COMMUNICATION:Seizures Discharge Instructions----------------------------------------------------------------------------------------------------------------------Seizures can be caused by many different problems. Some of these are called intracranial disease (within the brain) and others are extracranial disease (outside of the brain). Your veterinarian would have discussed these possible causes with you during consultation. To determine the cause of seizure activity sometimes many tests must be performed including blood work and specialist imaging such as a CT or MRI. Epilepsy is a common cause of seizures in younger dogs however can only be properly diagnosed once all of the other causes of seizures have been ruled out. Depending on the frequency of seizures your veterinarian may prescribe medications to prevent further seizure activity. Once a pet is on seizure medications they are on them for life, and they can not suddenly stop the medication for any reason. Monitoring at home:- It is expected from time to time, break through seizures will occur. Every dog’s brain is different and varying doses and types of medication will be required.- Medication is often needed to prevent seizures. Eden is not being started on this at this time, as it will depend on how often she has seizures, and the cause. - If your pet has any more than 2x seizures in a row (a break in between each seizure) or a seizure lasts more than 3 minutes, he or she will need to be seen by your primary care veterinarian, otherwise contact PVE if outside of your vets normal hours. What to DO during a seizure:- Protect the pet from injuring themselves during or after the seizure - remove any objects that they may collide with. Keep them from falling from a height and especially keep away from water. - Remove other pets from the area as some pets become aggressive after a seizure.- Protect yourself from being bitten. - Record the time the seizure begins and ends, and if it started with a certain body part (such as twitching of an eye). Also record the type of movements your pet experiences.- If the seizure or convulsion lasts over 3 minutes, seek veterinary attention immediately.  - If your pet has two or more seizures in a 24-hour period, seek veterinary attention immediately.- If your pet has one seizure that is less than 3 minutes and seems to recover completely, contact your veterinarian for further instructions.What NOT to do during a seizure:- Do not place your hands near the pet's mouth (they do not swallow their tongues). You risk being bitten. - Do not slap, throw water on, or otherwise try to startle your pet out of a seizure.Long Term Management Plan:- Please arrange a recheck in the next 7 days with your primary care veterinarian- You can expect frequent rechecks with your primary care veterinarian in the first 6 months to make sure the correct dose is being given.- As some of the anti-seizure medications can interfere with proper liver function, frequent rechecks are recommended to ensure that medications are not having adverse effects.Medications At Discharge: - Gabapentin Tablets 600mg: Give one tablet the night before, and again two hours prior to veterinary consult. May cause mild sedation. - Midazolam 5mg/1mL Amp: In the event of a seizure, remove cap and administer entire syringe (0.8ml) into noseIf your pet's condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency.  Thank you for trusting us with the care of your pet.    Vital Signs    Weight: 19.2;       

Reason: L4 Head collision With Glass Door Appointment Notes: Overdue reminders HISTORY: - Eden accidentally ran headfirst into a glass door this morning when she was running full speed. - Throughout the day, she has not been really acting herself, has been slightly snappy towards the owner and was intermittently slightly sleepy although she still has episodes of awareness, will get up, and run to the door and bark. She will then be sleepy again afterwards, however, which is not like her. - She still ate a little bit this morning and is normally a fussy eater and so this appetite was normal. - She has been drinking normally throughout the day.  - There is no vomiting, diarrhoea, or ataxia. - She was on medications last week [amoxyclav and meloxicam] for a cut on her paw pad.  Current meds: NoneProphylaxis: Up to date with vaccinations, flea, and wormingPre-existing conditions: NoneAccess to toxins e.g., Rodenticide: The owner says no known access to toxins [i.e., mulch, compost, snail and slug bait, rat bait, cockroach bait], rubbish, medications, chemicals nor any other thing that could have been scavenged.  TRIAGE: HR: 80 bpm = PRRR: 28 breaths/min Temp: Not takenMM: Pink, moistCRT: <2 secMentation: BAR [anxious]Pain Scale (0-4): 0/4 Hydration status (%): No hydration deficits, clinically adequateBody Condition Score: 5/9 EXAMINATION: Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait. A full neurological examination was not performed. Musculoskeletal: Ambulating independently with unremarkable gait. Full orthopaedic examination not performed. Gastrointestinal:- Oral: Normal, no mouth pain, dental score (1-4): 1/4  - Abdominal: No detectable pain and comfortable on abdominal palpation, normal gut sounds- Rectal: Not performed, faeces: Not visualised  Urinary: No significant findings, bladder small on palpation. Reproductive (incl ext genitalia): No significant findings. Integument/Ears: No significant findings. Lymph Nodes: Peripheral lymph nodes are palpably normal and symmetrical. No abnormalities were noted. Eyes: No significant findings, clear with no ocular discharge or lesions noted. PROBLEM LIST:1. Lethargic after head trauma    DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS: Mild Concussion vs Mild Traumatic Brain Injury vs Pain from the Trauma    DIAGNOSTICS/ MANAGEMENT PLAN: No diagnostics were performed. ASSESSMENT: Eden’s vitals are all within normal limits. Her pupils are equal in size and her direct and indirect pupillary light reflexes are present. She had no pain on the palpation of her head, neck, and spine and is with no neck pain on the manipulation of the head. She has good ambulation as well and so there is no current evidence of traumatic brain injury.        TREATMENT:                                                                            No treatment was given [in the hospital]. PLAN: The patient is stable for discharge home and is to haveongoing care and monitoring with strict rest at home for the next 3 days. Otherwise, as outlined in the discharge instructions below.Owner Communication: DISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Treatment summary: Eden's physical exam today is unremarkable - all her vitals are stable and she is not showing any signs of traumatic brain injury from her head collision this morning. She is stable to be monitored at home. If you notice any wobbliness/unsteadiness on her feet, decreased mental awareness, pinpoint pupils, vomiting, or any other abnormalities please have her reassessed by a vet.Exercise:- Please keep your pet rested for the next 3 days then gradually reintroduce normal activity.Recheck:- Please organise a recheck for your pet with your primary care veterinarian if she is not back to her normal activity in 3 days timeIf your pet’s condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency.  We are open from 6pm until 8am Monday to Friday and 24h over weekends and public holidays. Phone 1300 040 400    Vital Signs    

Reason: L2 Rat Bait IngestionHISTORY:- See previous history. In hospital with PVE Tuesday night- Wednesday (08/03-09/03) for gritty material moving from the stomach through the small intestine. Also possible rodenticide ingestion (coagulation normal and thoracic radigraphs normal). She was prescribed laxatives to help move the gritty material. - Since being home blood clotting was repeated at the primary care vet and was normal on Thursday (10/03). - She has passed hair and tendon looking material in her faeces. They have been smaller faeces with intermittent diarrhoea for the past couple days. No obvious chunk of foreign material.- Eating only small amounts of biscuits and chicken, not her normal appetite. - Panting more than usual after exercise and taking like and hour to settle with ongoing panting.- Today (Saturday 12/03) had a piece of rodenticide in her mouth, owner grabbed it out as soon as she could (within 60sec). Current meds: Metronidazole, and cerenia tablets - none given recently. Laxatives - last given Thursday.Prophylaxis: Up to date. Access to toxins eg. Rodenticide: TRIAGE:HR: 130RR: PantingTemp: Mm: pinkCrt: <2secMentation: BAR - very excitedPain Scale (0-4): 0Hydration status (%): hydratedEXAMINATION:Body Condition Score: 2.5/5Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  0- Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: no detectable abnormalities, faeces:  normal brown faeces with some grittyness.Urinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: peripheral lymph nodes normalEyes: NSFPROBLEM LIST:1. Possible Rodenticide ingestion today2. Reduced appetite3. Intermittent diarrhoea4. Increased pantingDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Differentials for GIT symptoms 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:> Radiology : Digital radiography was performed.Views: Lateral and VDThoracic: Extra thoracic structures: No significant findings.Diaphragm: No evidence of herniation and diaphragm appears intact.Pleural space: No evidence of pleural space disease.Large airways: No significant findings.Pulmonary: No significant findings. No evidence of interstitial or alveolar lung pattern.Cardiac: No significant findings. No evidence of cardiomegaly.Oesophageal: Normal location and no evidence of foreign material.Abdominal:Extra-abdominal structures: No significant findings.Serosal detail: Good.Liver/spleen: No significant findings. Normal location and appearance.GIT: small amount of gritty mineral opacity and soft tissue opacity in the pyloris region. Moderate amount of faeces with some gritty mineral opacity. No obstructive pattern noted.Kidneys: Normal location and shape.Bladder/Prostate: No significant findings.ASSESSMENT:Eden presented after chewing a rat bait, emesis performed and no rat bait retrieved. No charcoal or coagulation bloods indicated at this stage as it is considered unlikely that she ingested any rat bait today.Repeat abdominal radiographs performed due to ongoing intermittent diarrhoea, and reduced appetite. No obvious obstructive pattern. Ongoing monitoring recommended and a specialist abdominal ultrasound if there is any vomiting, diarrhoea, not eating or lethargy. TREATMENT:> See flowsheet record attached.PLAN:- Discharged to owners care. Follow instructions below. CLIENT COMMUNICATION:Discharge Instructions: ----------------------------------------------------------------------------------------------------------------------Treatment Summary:Eden presented following rodenticide ingestion. She was made to vomit and no obvious rat bait was in the vomit material. No charcoal or repeat blood tests are required at this time. But still monitor her closely for any signs of lethargy, pale gums or bleeding. She had repeat radiographs performed and found most of the grit within the large intestine. There was a very very small amount of grit in the stomach. This is unlikely to cause any problems but if there is any vomiting, diarrhoea, lethargy or reduced appetite then a recheck would be recommended. Exercise:- Please keep your pet rested for the next 3 days to continue to let her gastrointestinal upset recover.Diet:- Continue to feed a bland diet of cooked chicken and rice or bland dog biscuits for the next 3-5 days, then transition onto her regular diet. Recheck:- Please organise a recheck if you have any ongoing concerns. Medications:- Discontinue the lactulose/laxative.- If you think she has a reduced appetite then you can give the Cerenia tablet as directed on the label. If your pet’s condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call our team.    Vital Signs    Weight: 12.5;