C09990112 / invoice 10000

HAEMATOLOGY
RBC Count 8.16 x10^12/L ( 7.26 - 11.51 ) [* ]
Haemoglobin 117 g/L ( 103 - 159 ) [* ]
Haematocrit 0.33 L/L ( 0.30 - 0.46 ) [* ]
MCV 41 ( 37 - 49 ) [ * ] fL
MCH 14 pg ( 13 - 17 ) [* ]
MCHC 353 g/L ( 321 - 368 ) [ * ]
% Reticulocytes 0.1 % ( 0.1 - 0.8 ) [* ]
Reticulocytes *6 x10^9/L ( 10 - 60 ) *[ ]
Reticulocyte Haemoglobin 16.9 pg ( 12.5 - 18.0 ) [ * ]
WBC Count 8.9 x10^9/L ( 4.3 - 14.4 ) [ * ]
% Neutrophils 66 %
Neutrophils 5.9 x10^9/L ( 2.1 - 9.1 ) [ * ]
% Band Neutrophils 0 %
Band Neutrophils 0.0 x10^9/L ( 0.0 - 0.1 ) [* ]
% Lymphocytes 15 %
Lymphocytes 1.4 x10^9/L ( 1.0 - 6.9 ) [* ]
% Monocytes 4 %
Monocytes 0.4 x10^9/L ( 0.1 - 0.5 ) [ * ]
% Eosinophils 14 %
Eosinophils 1.3 x10^9/L ( 0.1 - 1.7 ) [ * ]
% Basophils 1 %
Basophils 0.1 x10^9/L ( 0.0 - 0.1 ) [ * ]
Blood Film Evaluation: RBC and WBC normal in morphology.
Platelets are clumped and within normal limits.
Platelet estimate from the smear is > 300 x 10^9/L.

CHEMISTRY
Total Protein 65 g/L ( 61 - 83 ) [* ]
Albumin 29 g/L ( 28 - 40 ) [* ]
Globulins 36 g/L ( 29 - 50 ) [ * ]
Albumin:Globulins Ratio 0.8
Glucose, serum 4.1 mmol/L ( 3.8 - 7.4 ) [* ]
Glucose, Fl Ox No Fl Ox tube received
Bicarbonate 19 mmol/L ( 15 - 24 ) [ * ]
Sodium 155 mmol/L ( 148 - 157 ) [ * ]
Potassium 4.4 mmol/L ( 3.7 - 5.5 ) [ * ]
Chloride 122 mmol/L ( 112 - 122 ) [ * ]
Anion Gap 18 mmol/L ( 15 - 26 ) [ * ]
Calcium 2.3 mmol/L ( 2.2 - 2.6 ) [* ]
Phosphorus 1.6 mmol/L ( 1.0 - 2.1 ) [ * ]
Urea 11.2 mmol/L ( 5.8 - 11.5 ) [ * ]
Creatinine 112 ?mol/L ( 69 - 160 ) [ * ]
Bilirubin, Total 2 ?mol/L ( 0 - 4 ) [ * ]
ALT 72 U/L ( 19 - 97 ) [ * ]
ALP 35 U/L ( 11 - 46 ) [ * ]
GGT <1 U/L ( 0 - 5 )
AST 37 U/L ( 19 - 57 ) [ * ]
Creatine Kinase (CK) 358 U/L ( 66 - 444 ) [ * ]
Cholesterol 3.5 mmol/L ( 2.6 - 7.5 ) [* ]
Triglycerides 1.03 mmol/L ( 0.10 - 1.40 ) [ * ]

Serum Indices
Haemolysis Index +
Icterus Index Clear
Lipaemia Index Clear

AVC comments: 
We are pleased that the bloodwork is unremarkable and Jasper is tolerating his medications well. We will see him in 4 weeks for a clinical exam, blood and urine tests.

Oncology summary for Jasper

Date 2nd March 2026

Diagnosis: Left lingual salivary gland adenocarcinoma with spread to left and right retropharyngeal lymph nodes

Response to treatment: partial clinical response based on improvement in clinical signs and no overt progression on exam.

Exam findings:
- mandibular lymph nodes are stable/symmetrical
- retropharyngeal lymph nodes not palpable
- soft and comfortable abdomen
- brief oral exam unremarkable (though could not look at back of base of tongue)

Tests:
Blood collected for external CBC and chemistry, results pending

Treatment plan:
- Palladia 10mg give by mouth on Monday, Wednesday and Friday with pre-treatment using maropitant 4mg (1/4 tabelt) 1 hour prior. Do not give Palladia if Jasper is off food/seems unwell. Give a break until back to normal
- Ondansetron 4mg tablets (script sent home today): give HALF (0.5) tablets by mouth every 8-12 hours on Palladia off days (can also be given in combination with maropitant) if needed for inappetance/nausea
- Onsior 6mg tablets: Give on Palladia-off days, only if Jasper is well in himself and eating. Give with food.
- Gabapentin 100mg: Give 1 capsule 1-2 hours prior to vet visits to reduce stress

If you find Jasper's appetite remains low despite the above plan, stop the medication, allow him to return to 100% normal , then trial Palladia every THIRD day.

Please keep in touch with any questions or concerns you may have.

Next visit: 4 weeks for exam, blood and urine tests

Diagnosis: L caudal lingual salivary gland adenocarcinoma w/ metastasis to L+R retropharyngeal LNs. Concern for early regrowth locally based on staging CT.
Treatment: Commenced toceranib 10mg PO EOD + robenacoxib 6mg PO alternating with toceranib on 3/2/26
Response to treatment:
Other medical history/co-morbidities:
- possible hyperthyroidism (clinical significance unknown), R thyroid nodule observed on staging CT
- splenic heterogeneity incidentally noted on staging CT
Current medications:
- gabapentin 100mg PO prior to vet visits (not given today)
- Palladia 10mg PO EOD
- robenacoxib 6mg PO EOD alternating with Palladia
- maropitant 4mg PO SID daily for the last week
History since last visit: Since starting Palladia, Jasper's appetite is reduced, though it is partly improved with daily anti-emetic. Does require dose delays (
One episode after licking glove hypersalivated.
Increased thirst, but eating less wet food. No more coughing/sneezing.

Current diet: Dry food (Hill's science diet, adult)

Physical Examination findings: 
Demeanour: BAR, friendly
Body condition score 4/9 good
MM pink, CRT< 2 secs, HR 200, RR 40 but stressed/anxious, Temp NT Wt: 4.8kg
Oral: Allowed brief exam while consious - unable to assess under tongue but no overt mass lesions identified
Eyes: no concerns noted
Ears: no concerns noted
Nose: no concerns noted
Integument: Palpable thyroid slip R side approx 4-5mm
Lymph nodes: L + R mandibular nodes prominent but bilaterally symmetrical approx 6-7mm. Unable to palpate retropharyngeal LNs.
Cardiovascular: no murmur or arrhythmia on auscultation, pulses strong and synchronous
Respiratory: normal bronchovesicular sounds bilaterally, normal rate and effort
Abdomen: no fluid or masses on palpation, soft and comfortable
Rectal: NE
Musculoskeletal: ambulatory x 4, normal gait, full MSK exam not performed
Neurological: no abnormalities noted, full neurological exam not performed

Laboratory:
Blood collected for external CBC + chemistry, results pending. Plan urinalysis if renal changes, if not, plan to collect at next recheck.

Assessment:
- L caudal lingual adenocarcinoma w/ retropharyngeal LN metastasis - no evidence clinical progression. Possible partial response given improvement in coughing/sneezing.
- Stable R thyroid nodule

Treatment:
- Reduce Palladia 10mg PO Mon Wed Fri with maropitant 4mg PO 1-2hr prior to administration
- Ondansetron 2mg PO BID-TID PRN nausea/inappetance (script sent home today) - advised can be bitter so trial and see how tolerates
- robenacoxib 6mg PO Palladia off days as long as is well
- Gabapentin 100mg PO prior to vet visits

Plan: Trial reducing dose intensity and increased prophylactic anti-emetics to see whether can improve tolerance.
If inappetance remains, plan to give Palladia every 3rd day.
Revisit in 4 weeks for exam, CBC, chemistry and urinalysis.
Repeat staging (ideal CT head, thorax) mid-late April 2026 to more objectively assess response.

Client communication: Discussed I am happy that Jasper appers to be benefiting from the treatment, however his tolerance is not ideal so we will need to tweak the dose schedule as above to improve tolerance. Family are happy with the plan

Next visit: 4 weeks for exam, external CBC, chemistry and urinalysis