C09979988 / invoice 10000

Reason: ChemoHistory: Tina presents for 2nd Cytarabine injection (currently her 2nd treatment of 3 weekly intervals)Christy queried if it was possible to reduce dose of steroid medications. Claims that Tina is seemingly panting quite often recently. See previous histories for details Current medications: 1. Prednisolone 30 mg PO q12h > To reduce to 30mg PO q24hProblem List: 1) Lethargy, hyporexia ~29/9/25 2) Depression, progressing to dullness 10/25 3) Spontaneous vocalisation/pain, localised to cervical pain 9/10/25 4) Weight loss 33 kg 9/24, 29.6 kg 9/10/25, 27.9 kg 24/10/25 5) Blindness 9/10/25 - improving (24/10/2025) 6) UMN tetraparesis and ataxia, reduced general proprioception - MRI and CSF cytology = mononuclear pleocytosis DDx MMUO 7) Absent nasal sensation - RESOLVED 8) Reduced gag reflex - RESOLVED 9) Relapse neurological signs 15/1/26 - CBC, NH3 biochemistry within normal limits except for mild ALT/ALP elevation - AFAST within normal limits; Brain and C-spine MRI - Almost complete resolution of the previously severe, diffuse meningitis, with resolution of the subdural fluid collection; Mild residual changes are still visible along the rostral falx cerebri and the osseous tentorium cerebelli; Almost complete resolution of the previously severe intramedullary changes within the cervical spinal cord, most consistent with incomplete resolution of meningomyelitis; CSF cytology = Cytologically unremarkable CSF; CSF Neurological PCR = within normal limits - Ddx MMUO relapse Examination: Neurological Mentation: QAR Gait: Ambulatory, no weakness or ataxia Cardiovascular HR: 96bpm MMs: Pink, moist CRT: 1.5s Pulses: Normal and synchronous Auscultation: No murmurs or arrhythmias Respiratory Rate: 24brpm Effort: Normal Pattern: Costoabdominal Auscultation: Normal bronchovescicular sounds Abdominal palpation: Comfortable, no obvious masses Temperature: 38.6C Passed regular stools in hospitalNeurological> Mentation: QAR Gait: No ataxia, normal ambulation Tone: Mildly increased HLs Spinal pain: TL and cervical pain - yelping Cranial nerves Menace (S CN2 - optic; M CN7 - facial): Present Palpebral (S CN5 Trigem; M CN7 - facial): Normal/present bilaterally PLR (S CN2 - optic; M CN3 - oculomotor): Present direct and consensual bilaterally Vestibulo-ocular reflex (S CN 8 - vestibulocochlear; M CN3/4/5 - oculomotor, trocholear, abducent): Normal Stimulation of nasal mucosa (S CN5 - trigeminal): Absent Jaw tone (S CN5 - trigeminal; M CN5 - trigeminal): Normal Facial symmetry (S CN2/5 - optic, trigeminal; M CN7 - facial): Normal Gag reflex (S CN9/10 glossopharyngeal, vagus; M CN9/10): Present and normal Tongue evaluation: Normal Normal physiologic nystagmus General proprioception Knuckling: Delayed in all limbs Postural reactions Hopping: Delayed Wheelbarrowing: Not assessed Hemiwalking: Not assessed Extensor postural thrust: Not assessed Spinal nerves Patella (Femoral n - L4/5/6): Normal to increased Pelvic limb Withdrawal (L6/7 S1/2): Normal Thoracic limb Withdrawal (C6/7/8, T1/2): Normal Sciatic (L6/7 S1/2): Normal Cranial tibial (L6/7 S1): Normal Perineal (S1/2/3, pudendal): Normal Deep pain present in all limbs Laboratory: CBC - Hct 42.8 %; Neu 3.39 x10^9/L; Plt 380 k/uL Assessment: The neurological deficits appear to be progressive, Tina has reduced facial sensation in addition to the previously documented reduced nasal sensation The second dose of Cytarabine was given today (currently on 3 weekly intervals) Treatment: Wt 27.5 kg = 0.920 m^2 Cytarabine injections 50mg/m2 SQ q2 hours for 4 injections = 46 mg = 2.3 mL (20mg/ml) Plan: 1) Taper pred to 30mg PO SID2) Recheck with next Cytarabine in 3 weeks 3) Client to monitor for setbacks 4) Extend the time between treatments by 1 week every 3-5 treatment cycles until an every 8-weekly treatment interval is reached then continued lifelong or discontinued based on the patient's clinical signs and owners preference (Perspectives on pharmacologic strategies in the management of meningoencephalomyelitis of unknown origin in dogs. Beasley & Shores, JFVS 2023) Other communication:    Vital Signs