C09991192 / invoice 10000

Reason: Urine Sample In Reception Fridge    Vital Signs    

Reason: RecheckHistory Summary:-Diagnosis: 2x MCTs on R distal limb, FNAs concerning for high grade. -CT staging 19/02, metastatic R PS LN, with occasional MCT in liver+spleen (not consistent with metastatic disease)-Prednisolone commenced 24/02.Other relevant history/comorbidities: B1 MMVD (echo with RW)History since last visit: Os returned yesterday, note that he seems much more brighter in himself. Seems more comfortable with his front leg as well, and have reduced frequency of panadol use. Some increased in water consumption but no changes to urination pattern. Eating well otherwise. Carer had no concerns looking after him this past week,Current medications;Prednisolone 20mg/kg PO SID (0.55mg/kg)Loratadine 10mg PO BIDParacetamol 500mg PO BIDPhysical examination:Weight 36.4kgBCS: 5/9T: x  P: 86  RR: Pant   MM colour: Pink CRT: <2sEyes: NADEars: NADNose: NADOral: Lips have a pale pink appearance, but gums itself appear pink Lymph nodes: Slight asymmetry associated with R PS LN Integument: 1. SQ mass on palmar aspect of right metacarpal region palpates softer this week measuring 41mm height x 32mm wide (was 49mm height x 47mm wide)2. SQ mass on medial aspect of right carpus is dorsal to mass 1, soft and smaller on palpation measuring 34mm height x 26mm wide (was 43mm height x 47mm wide)Respiratory: NADCardiac: Grade II/VI cardiac murmurAbdominal palpation: No organomegaly appreciableRectal examination: Not performed Urogenital/mammary: Normal MSK: No lameness associated with RTLNeurological: NAD, general exam only Laboratory:UoM Haematology:Neutrophils x 109/L 11.6 3.0 – 11.5 HUoM Biochemisty: WNLUoM General Urine Exam (free catch): O dropped this off @1430, pendingAssessment:Tumour response: SD, 22% reduction in size Baseline SLD 96mm, today 75mm -Some response to prednisolone alone, but not enough to allow surgical excision. Neoadjuvant treatment with vinblastine +/- palladia should be considered to further evaluate response for possible surgical excision. Would recommend adjuvant chemotherapy following surgery.-Alternatively consider ongoing medical management with vinblastine, palladia or prednisolone, with view to achieve shrinkage/maintain stable disease for a certain period of time.Treatment:Palladia 100mg PO EOD (2.74mg/kg) Medications at home:Prednisolone 20mg PO SID (0.55mg/kg)Loratadine 10mg PO BIDParacetamol 500mg PO BID-TID PRN Next visit:Recheck in 2 weeks for exam and tumour measurements.Client communication:- Discussed the nature of high-grade mast cell tumours and the implications of metastatic disease.- Discussed current goals, Os are considering marginal excision if Rusty's tumours respond and this is deemed possible but are reluctant to consider IV chemotherapy. Keen to trial palladia, advised that for neoadjuvant reasons vinblastine likely to have more impact, but will be guided by tumor measurements. - Discussed potential side effects of both intravenous chemotherapy and Palladia, including gastrointestinal signs (diarrhoea, vomiting, inappetence) and bone marrow suppression. Explained that side effects can vary between individuals, with both vinblastine and palladia likely having an equal risk of side effects. - Discussed the cytotoxic nature of intravenous chemotherapy and handling precautions, versus Palladia which works via a different mechanism and is not cytotoxic in the same way, though handling precautions (wearing gloves) are still recommended.- Surgery may still not be possible, and will be guided by surgeon's assessment as well. Discussed that the longer we wait, there is a risk of further disease spread.    Vital Signs    Weight: 36.4;