C09989430 / invoice 10000

Diagnosis Other relevant history/comorbidities:Chemo protocol:Treatment number: x/totalHistory since last visit:-     Appetite-     Thirst-     Urination-     Defecation-     Vomiting-     Other clinical signs-     Medications givenPhysical examination:WeightBSABCS:T: P: RR: MM colour:  CRT: Eyes:Ears:Nose:Oral:Lymph nodes:Integument:Respiratory:Cardiac:Abdominal palpation:Rectal examination:Urogenital/mammary:MSK:Neurological:49mm height x 47mm wide  tody: 41mm height x 32mm wide 2. Mass on medial aspect of right carpus is dorsal to mass 1, soft and SQ. Measures 43mm height x 47mm wide  today  34mm height x 26mm wide TodatLaboratory:Assessment:Tumour response: Toxicity from previous chemo:Treatment:Medications at home:Next visit:Diagnosis Other relevant history/comorbidities:Chemo protocol:Treatment number: x/totalHistory since last visit:-     Appetite-     Thirst-     Urination-     Defecation-     Vomiting-     Other clinical signs-     Medications givenPhysical examination:WeightBSABCS:T: P: RR: MM colour:  CRT: Eyes:Ears:Nose:Oral:Lymph nodes:Integument:Respiratory:Cardiac:Abdominal palpation:Rectal examination:Urogenital/mammary:MSK:Neurological:Laboratory:Assessment:Tumour response: Toxicity from previous chemo:Treatment:Medications at home:Next visit:    Vital Signs    

Reason: Teleconsult with NVS and CCClient Communication:-Relayed cytology findings, more recent addendum stating that no obvious concerning metastatic disease to liver and spleen. Mentioned that unable to completely rule out as region sampled may not be representative, but less likely.-Os have mentioned will not go down pathway of amputation so did not go through this.-Options discussed;1. Neoadjuvant VBL/pred for a few doses q1w to try to shrink and allow marginal surgical excision of masses + PS LN extirpation. Given that has metastatic disease to local LN, will follow up with course of chemotherapy VBL/Palladia (series of 8 overall for VBL, EOD at home for palladia). MSTs 6-8 months, unlikely to get years.$9k2. Medical management with chemotherapy either VBL/palladia ($3500/m) or palladia only ($1500). 3. Medical management with corticosteroids. -Chemotherapy associated side effects discussed. -Os have requested handout sheet reiterating the information. Os mentioned that they will consider these options, but are keen to commence steroids in the interim and will pick this up from us tomorrow (20mg PO SID). S/E of prednisolone discussed.-Reiterated that they do not need to make decision right now, can wait until they return next week.-Os requested revisit appt when they return, booked for 05/03.--- 25/02/2026 09:21:45 SIV:Sent email to Rajeev with treatment options handout, see attached in RXWorks25/02/2026 System Controller Regarding Rusty Hi Doctor, One quick query. We are getting feedback from Google and few of our pet owner friends, that Panadol (paracetamol) is not good for dogs. While we trust your decision but since we will be away, I feel like rechecking with you that it is ok to give him Panadol! Pls confirm. --- 26/02/2026 18:17:38 SIV: Sent emailHi Rajeev,Sorry for the slight delay in responding to you. I understand it can seem scary to use panadol, but if done safely with vet guidance there is often a very good benefit in dogs, and it is now easily one of the more commonly used pain relief options we have. There are of course risks associated with long term use, and we make careful selections of the types of patients we use it in. Rusty's liver markers on bloods were normal, and he is a very happy boy with no clinical issues. It often comes down to dosing, and Rusty is on the appropriate dose for his weight. Often times a lot medications do come with risks, carprofen for example can cause kidney injury which is why patients on it longterm will need routine bloods done, and we avoid the use of it in patients with kidney marker elevations on blood! I've attached a handout that discusses panadol use, feel free to have a read. If Rusty responds to the steroids and the inflammation improves, there may be the possibility he'll need panadol with slightly less frequency. Let me know if you have any other questions!    Vital Signs