C09974565 / invoice 10000

Reason: Vinblastine #4Intern: JL History: Kyla is a 5y11m FS American Staffy managed by the oncology department for a L stifle MCT (grade 3/high grade). 18/12/25 – Presented for a new 0.5 cm alopecic lump on L hind lateral thigh with scab over it. Been there for a week. Appears to be more subdued than before. In-house cytology consistent with MCT. Commence chlorpherniramine and omeprazole. 22/12/25 – Presented for worsening V+ (green, thick), D+ inappetence and lethargy despite starting on omeprazole and antihistamine. Admitted for symptomatic tx (fluids, methadone, maropitant). Several large volume regurgitations and diarrhoea observed during hospitalisation. Abdomen was tense on palpation. Stomach decompression was carried out with endoscopy for suspected FB. No FB found. Changed from omeprazole to famotidine.  - Bloods: Elevated ALT (141u/L) and Creatinine (156 umol/L)24/12/25 – D+ relapsed, now orange. Lethargic. Tx presumptively for IMPA secondary to GE (meds listed below).Commenced steroids.07/1/26 – Surgical removal of MCT carried out (progressed to 1x1cm, ulcerated). Unable to get adequate depth for margins as mass was sitting right at the edge of the stifle joint.IDEXX Histology report:INTERPRETATION:Inflamed cutaneous mast cell tumour, grade III (Patnaik), high grade (Kiupel)Mitotic count: 7 in 2.37mm2Histologic tumor-free margins: Clear; the nearest peripheral margin is 6.7 mm, with the nearest deep margin 4.0 mm consisting of underlying adiposeVascular invasion: Not presentHISTOLOGICAL DESCRIPTION:Haired skin contains a poorly circumscribed, extensively infiltrative, predominantly dermal nodule with infiltration of the deep subcutaneous tissue. The nodule is composed of pleomorphic round cells which form solid sheets, cords, and nests. The neoplastic cells have distinct cell borders, amphophilic cytoplasm with basophilic cytoplasmic granules, and a round, centralized nucleus which contains vesicular chromatin and an indistinct nucleolus. There is moderate anisocytosis and anisokaryosis, and a total of 7 mitotic figures are counted in 2.37 mm2. Eosinophils are present throughout the mass. The overlying epidermis is extensively ulcerated with some necrosis and there is intense infiltrates of mixed inflammatory cells including lymphocytes, plasma cells and neutrophils throughout the lesion.8/1/26 – Acute onset bloody D+, inappetence, progressive lethargy post-surgery. Polydipsia but regurgitating water. Wound dehiscence post-surgery. 12/01/26: Presented to ARH Oncology. OR improvement in surgical site bruising and energy levels. No further vomiting, diarrhoea. Ongoing polyphagia/PU/PD following prednisolone commencement. Physical examination noted moderate seroma formation and slight oedema to surgical site, bruising extending into inguinal region. Discontinued metoclopramide, tapered prednisolone (discontinued on 17/01/26). Commenced chlorpheniramine 8mg BID, amoxyclav 625mg BID. Recommended CT staging, SLNM, FNA of sentinel LN, liver and spleen. Recommended transition to GI diet (Hills I/D). 19/1/26: CT staging, noting the following pertinent findings: Mildly enlarged left inguinal lymph nodes: Reactive – metastatic 2. Sublumbar lymph nodes are of normal appearance, no evidence of metastases 3. Liver and spleen are of normal appearance, not suggestion of metastases 4. Left kidney cyst 5. Thorax normal, no pulmonary or lymph node metastases. 6. Left lateral thigh region with fluid pockets (seroma), edema and diffuse subcutaneous swelling post surgery, but no macroscopic massesIn house FNAB of L inguinal LN identified one mast cell only. FNAB of liver and spleen to QML – both consistent with benign sampling. 22/1/26: Vinblastine commenced @ 2mg/m2. Palladia withheld an additional 7 days to allow for final wound healing. 29/1/26- commenced vinblastine and palladia. - day 7 CBC nadir N: 5.89Kyla has been O's friend dropping off, advised may be a couple of minutes late. O picking up if any questions, but O says that Kyla has been going very well, no D+, maybe slightly gassy but no other concerns. SHD Kyla is doing well - gassy no d+Current diet: Plain chicken and rice. Was originally fed pet mince, chicken, pumpkin and advanced kibble. To commence RC GI or hills  I/DOther pertinent medical hx.3/2023 - Heat stress episodeSensitive GIT- gets diarrhoea oftenExamination findings: Demeanour: BARWeight:  kg MM: Pink, moist  CRT: <2s  HR:  bpm  RR: brpm T:   COcular: WNL  Aural: WNL  Nasal: WNL  Oral: WNL  Cardiovascular: No evidence of murmurs or arrhythmias. Femoral pulses strong and synchronous.  Respiratory: Bronchovesicular lung sounds in all 4 quadrants with no evidence of any crackles or wheezes.  Abdomen: WNLLymph nodes: peripheral LNs palpate WNL Integument:- Linear surgical wound on the caudolateral aspect of the left stifle - complete epithelialisationMSK: WNL  Gait: NAD Urogenital: WNL  Neurological: WNL  Rectal: Not performed Laboratory: Inhouse IDEXX CBC - see attached resultsNEU  8.65 x10^9/L (2.95 - 11.64)PLT 269 K/µL (148 - 484)Blood pressure: Size 3 Tail 128/59 (78) – normalAssessment:High grade grade 3 MCT (LPL thigh) - close excision  7/01/26 MC 7 (Histologic tumor-free margins: Clear; the nearest peripheral margin is 6.7 mm, with the nearest deep margin 4.0 mm consisting of underlying adipose)- Surgical wound site seroma formation, ongoing healing (Surgical excision carried out on 7/12/26 with wound dehiscence occurring on 8/1/26).- CT staging and SLNM 19/01/26 -> left inguinal node primary sentinel node, no evidence of further nodal involvement/metastasis. Preliminary CT findings not suggestive of gross abdominal or pulmonary metastasis. - L inguinal node FNA -> negative - Liver and spleen FNA -> benign sampling CHEMOTHERAPY- VBL #1 commenced @ 2mg/m2 on 22/1/26 --> day 7 nadir: NEU: 3.04, PLT 294Convert to VBL/palladia combined protocol on 29/1/26. - VBL #2 administered @ 1.6mg/m2, palladia @ 2.5mg/kg on 29/1/26 - VBL #3 administered @ 1.6mg/m2, palladia @ 2.5mg/kg on 29/1/26 IMPA (presumed reactive/secondary to gastroenteritis) - diagnosed 24/12/25 - Presumed clinical remission as of 19/01/26; further diagnostics (joint aspirates, CRP) not performedMild biochemical hepatopathy (ALT and ALKP mild elevation) - NEW finding 19/01/26 - No evidence of hepatic metastasis on in-house cytology, external results pending Treatment:Vinblastine 1.6mg/m2 (mg, ml) administered in the vein via closed equahield system.Flushed with 0ml sterile saline.Administered by , held by Continue: Palladia @ 80mg (1 x 50mg and 2 x 15mg) PO M, W and F. Dispensed by CH, checked by KM.Prednisolone 20mg T,T,S&SContinue: - Chlorpheniramine 8mg PO BID- Famotidine 20mg PO BIDAs needed: - Prokolin 7ml PO BID- Maropitant 60mg PO SID - Paracetamol 250mg PO BIDClient communication:Plan:Recheck 14 days for CBC, UA, BP, vinblastine #5/palladia- offered restaging, will need to be a drop off appt, estimate $2300    Vital Signs    Weight: 32.7;