C09984990 / invoice 10000

Notes from FM:Splenic nodule found tail of spleen just caudal to hilus 4x3mm - monitor - have updated Judy about this incidental findingHypoechoic lesion 4x6.5mm todayNot pushoing out capsule, within tissue of spleen. No distortion of vv.Recheck in 1 month.Zydax given Supplied prokolinOn synbioticPred 5mg 3/4 sidCyclosporine 0.35ml per day.Eod b12Plan: Finish zydax courseIn 2-3 weeks to reduce prednisolnoe to 5mg sid and continue cyclosporine4 weeks repeat spleen u/s    Vital Signs    Weight: 7.1;       

Reason: Vets North Email Appointment Notes: Special payment terms exist, Overdue remindersTolerating Cyclosporine doses well - no vomitingStools normal todayJudy happy with the planComing in next wednesday for me to u/s her spleen and check her    Vital Signs    

Hi Faon,Glad to hear Layla is doing overall better. I would keep her on the lowest effective dose of pred to control her GI signs that causes minimal or acceptable side effects. If her GI signs are controlled on 3.75mg of pred, then stick with that for now. The cyclosporine add was in case things went pear-shaped on the lower dose of pred, then at least we would already have cyclo in her system but fine to add this in later. With IBD, initally we aim for immunosuppression but if the patient shows promising improvement early on or if there are significant adverse effects from steroids, an anti-inflammatory dose can be just as an effective! Unfortunately, these cases are not txt book and my mantra is- treat the patient, rather than follow a prescriptive formula. If you decided to add in the cyclo now, then in terms of how long she is on the low dose pred regimen is unclear but I usally don't do more than a 25-30% pred taper every couple of weeks. She may be on cyclosporine life long but if the patient has been in remission for several months, then I might consider dropping the cyclo dose a bit. With IBD it can be very cyclical, meaning we get seasons where we have a good response from a sniff of immunomodulatory drugs and then seasons where we are throwing the kitchen sink at them and they are not responding well. Maintaining a novel protein/hydrolysed strict diet (sometimes we need to change things up with a different brand or formulation) is critical for long term success and ongoing use of synbiotics/probiotics.Hope this helps.Charges include $56 for this review. (Max 3 attachments / 2 organs / 3 views for radiographs)Warm regards,Tunbi VereBSc BVMS FANZCVS (SAM) | Internal Medicine Specialist Consultant    Vital Signs