C09984264 / invoice 10000

Reason: ChemotherapyIntern: History: Ellie is a 8y 4m Rhodesian Ridgeback X who presents to ARH Oncology for recheck for further dispensing of LDC and TKI following detection of recurrent LN metastasis. She is managed for right anal gland adenocarcinoma. 24/9/24 - RegVet - R anal gland sacculectomy for AGASACA. 24/10/24 - ARH oncology - CT 5/11/24 - LN extirpation. 20/11/24 - Surgical recheck: surgical site healing well, no evidence of recurrence on rectal palpation. MACROSCOPIC 1. Sacral LN: The specimen consists of a lymph node measuring 53 x 38 x 24 mm. The cut surface is spongy and pink with areas of cavitation. 4RS 1A-1D. 2. 2 x sublumbar LN (chain): The specimen consists of a ragged piece  of tissue measuring 35 x 14 x 7 mm with 2 lymph nodes measuring 7 and 8 mm. The tissue is inked blue and is submitted in toto as 4 pieces 2A-2B. MICROSCOPIC 1. The lymph node is expanded and effaced by sheets of moderately pleomorphic epithelial cells with a trabecular to solid and occasionally acinar growth pattern. These cells have ample eosinophilic cytoplasm, ovoid vesicular nuclei and generally small/inconspicuous nucleoli. In places there are more than 10 mitotic figures per hpf. 2. These sections of lymph node exhibit mild sinus histiocytosis. Neoplastic cells are not evident. DIAGNOSIS: 1. Metastatic adenocarcinoma of apocrine gland of anal sac (sacral lymph node) 2. Reactive lymph nodes (sublumbar) COMMENTS: 1. Metastasis of this high grade malignancy is confirmed. 2. There is no obvious evidence of neoplastic cells in these multiple sections of sublumbar lymph nodes.20/2/25: LDC + palladia commenced. 30/4/25: Intermittent diarrhoea reported. 8/10/25: Sacral LN remains static on US except changes with fluid accumulation or an intra-nodal bleed. 17/12/25: Sacral LN remains static on US. Soft tissue nodules (DDx early metastasis, granulomas) identified on CxR. Recommended to bring the next staging forward- 3x CXR + focal US of sacral LN in 4 weeks time. Ellie presents today for a CBC, BP, UA, further dispensing of medications and staging.  Owners report Ellie has been doing well, EDDU normal. Had a small amount of diarrhoea last week (Owner stopped Palladia Monday and Wednesday). Diarrhoea cleared so recommenced Palladia Friday. Has been great since. Owner has noticed this week that Ellie is acting like she has a UTI - small amts of urine regular. Owner did not administer any medications this morning. Owner brought in a urine sample this morning. Current medications:- Cyclophosphamide 15mg PO SID - Palladia 75mg PO M, W, F- Frusemide 20mg: Give 1 x 20mg PO SID with cyclophosphamide in the AM- Meloxicam 1.5mg/ml oral suspension: 30kg dose PO SID --> withhold until diarrhoea resolvesAs needed: - Maropitant 160mg: 1/2 tablet (80mg) SID as needed for nausea/vomiting - Pro Kolin: 7ml PO BID as needed for diarrhoea Examination Findings: Demeanour: BAR Weight: 29.2kg BCS: 5/9 T:  37.7C            MM: pink P:   132 bpm        CRT: 1-2 s R: 28bpmCardiovascular: no auscultable murmur or arrhythmia, femoral pulses strong and synchronousRespiratory: clear bronchovesicular sounds bilaterally across lung fields, respiratory effort normal Abdomen: WNL; soft and comfortable to palpate, no immediately palpable masses or fluid wavePeripheral LNs: WNL; submandibular, prescapular and popliteals all appropriately sized and symmetrical Eyes: WNL; eyes clear and symmetrical, no ocular discharge, inflammation or blepharospasmEars: WNL; ears externally clean, no discharge or inflammation Integument: R prescapular - 1x1 cm soft mobile subcutaneous mass5cm diameter erythematous alopecic lesion to dorsal mid trunk - resolvedR lateral flank (edge of caudal ribs) firm cutaneous nodule ~1.5cmOral exam: WNL; mucous membranes pink, dentition WNL  Musculoskeletal: WNL; weight bearing x4 limbs, no noted muscle asymmetry, no noted neck pain on movement. Full MSK examination not performed. Gait: WNL; ambulating well, no observed lameness or ataxiaNeurological: WNL; mentation appropriate, response to environment appropriate. CPs appear intact, menace and palpebral intact. Full neurological examination not performed. Rectal exam: normal faeces present on glove. No palpable recurrence. Can feel the sacral N at the end of finger.Diagnostics:IDEXX CBC In house: see attached resultsHCT:  % (37.3-61.7) NEU:  x 10^9/L (2.95-11.64) PLT:  K/uL (148-484)Blood smear: Confirmed aboveUrinalysis: Voided/ free catchColour: dark yellowClarity: cloudy, sediment throughout  USG >1.050DipstickLeu 1+Nit negGLU  negPRO 3+KET 1+UBG negBLD/Hb 4++BIL 1+PH 8BP - LPL cuff #3 average: 193/163 (172)Radiographic Findings: Interpretation:Ultrasound Report: Assessment: R sided AGASACA recurrent LN metastasis Stage 3a- 3 months post-op sacral LN extirpation- 5 months post-op R AGASACA with RegVet - 20/2/25 --> sacral lymphadenopathy consistent with metastatic disease. - 26/3/25 --> sacral lymphadenopathy static - 04/06/25 --> sacral lymphadenopathy static - 29/08/25 --> sacral lymphadenopathy progressive- 08/10/25 --> sacral lymphadenopathy static, cavitation/heterogenous appearance - 12/11/25 --> sacral lymphadenopathy static in size, more cavitation - 17/12/25 --> sacral lymphadenopathy static cf 08/11- 28/01/26 --> sacral lymphadenopathy static cf 17/12/25 NEW 19/12- thoracic rads detected soft tissue nodules, concerning early mets - Changes appear largely static 28/01/26  Anaemia 30/4/25 - Non-regenerative/ pre-regenerative, normocytic, normochromic - RESOLVED DDx: Bleeding/ inflammatory disease (neoplasia)Treatment: Sedation: Butorphanol 0.3mg/kg IM Trazodone 150mg POContinue: - Cyclophosphamide 15mg PO SID with 20mg frusemid PO SID - Palladia 75mg PO M, W, F--> dispensed by KR, checked by JK.- Meloxicam 1.5mg/ml oral suspension: 30kg dose PO SID As needed: - Maropitant 160mg: 1/2 tablet (80mg) SID as needed for nausea/vomiting - Pro Kolin: 7ml PO BID as needed for diarrhoea Client communication: . Plan:Recheck CBC, BP, UA, Palladia in 28 days Repeat U/S of LN Feb 2026Repeat thoracic radiographs March 2026MBA (due April 2026)    Vital Signs    Weight: 29.2;       MMColour: Pink;       Temperature: 37.7;       HeartRate: 132;       RespirationRate: 28;       BP: 193/163(172);       CRT: <2;