C09971102 / invoice 10000

01/03/2026 DATE/TIME of CONSULTATION: 11:43hrs, Sun 01/03/26
CLINICIAN:  EB 
PRESENTING COMPLAINT: NQR 
HISTORY:
oncology patient - large cell lymphoma -  as been refractory to treatment  mutiple treatment protocols 
recent hx of UTi- last C&S - 15/2- negative after courses of clav and enrofloxacin
currently on  pred 10mg sid, denamarin and proplain q8hrs

ALT and ALP up last oncology visit

last night panting and appeared uncomfortable again today 
eating ok
no vomiting
faeces soft and possible malena but owner admits not fresh when examined

CLINICAL FINDINGS: Mentation: QAR  HR: RR: MM :pink but possibly yellow tinge to sclera CRT:  <2  Temp .  39.5 - done at home before visit 

Cardiovascular: no notable murmurs or arrythmias auscultated, femoral pulses good and synchronous
Respiratory: normal respiratory rate and effort, normal bronchovesicular sounds on auscultation, no visible nasal discharge
Gastrointestinal: soft comfortable abdomen on palpation, no strong repeatable focus of pain,
Rectal exam: n/a 
Lymph Nodes: no peripheral lymphadenopathy noted

PROBLEM LIST:
refractory lymphoma
hx of UTI
panting/restless last night and ongoing today
mild pyrexia 39.5 at home 
possible malena 

DIFFERENTIALS:  panting recurrence of UTi vs discomfort/pain -  malena- medication vs  GI bleeding 

DIAGNOSTIC TESTS:
urine- usg 1.010
ph 6, negative protein ,no blood 

pcv/tp 27/63

CBC-  non regenerative/preregenerative anaemia- HCT 0.228
leukopenia-  3.92 ( 5.93 last visit)
neutropenia 2.77 and lymphopenia 0.87
low platelets- possible lab error- not confirmed by smear

biochem
ALP 451- improved
aLP 1595- improved
TBil 4
GGT 20 


AFAST- no FF all 4 quadrants  

DIAGNOSIS:
concern about anaemia and possible GI disease/progression of lymphoma 
booked for revisit with oncology  10/3 with ultrasound planned 

TREATMENT:
maropitant 1mg/kg sc 
clav 500mg bid- neutropenia and pyrexia
gabapentin 300mg  bid or as required- if too sedated give 1/2 capsule - 
omeprazole 20mg bid 

CLIENT COMMUNICATION/PLAN:
oncology will call tomorrow to follow up and possibly bring forward appointment
recommend recheck PCV/ Tp in 48 hours a regular vet