C09993705 / invoice 10000

Haven is responding well to corticosteroid therapy for her SRMA, with complete resolution of her neck pain. The current concerns, including bloating, saggy belly, muscle weakness, polydipsia, and polyuria, are consistent with high-dose steroid side effects. The 2.3kg weight loss is likely due to muscle atrophy secondary to steroids. The pustular dermatitis is suspected to be a secondary bacterial skin infection (pyoderma), likely opportunistic due to steroid-induced immunosuppression. We will continue medical management. The prednisolone dose will be maintained at 10mg twice daily. If signs of neck stiffness recur, the dose will be increased to 15mg twice daily. A short course of antibiotics will be prescribed for the skin infection. Haven can exercise to her tolerance level, but contact with dogs of unknown health status should be managed. If the skin issues persist after the antibiotic course further dermatological investigation is recommended.

Comments: Haven's MRI revealed midl changes in her spinal cord suspicious of inflammation. Pending spinal fluid analysis andinfectious disease testing will help us confirm this diagnosis. This is most likely an immune mediated condition called steroid responsivemeningitis and arteritis (SRMA). It is unknown what triggers the immune system to use this reaction but SRMA is typically seen in dogsof her age with neck pain and pyrexia. Majority of them respond well to steroids as the name suggests but some cases may needongoing steroid treatment to stop having relapses.ADDENDUM (1.12.25): Spinal fluid analysis confirmed inflammation affecting Haven's central nervous system. Pending PCR results willconfirm if this is SRMA or infectious. I have updated Keita with this result. She reported minimal improvement in Haven, which isunusual for SRMA. I have requested CSF culture to be performed as well to rule out all the possibilities. Keita will update me Wednesdaymorning to report on her progress. I would much appreciate it if you could dispense 2 weeks worth of gabapentin as below for Haven.Keita will collect it from you.ADDENDUM (3.12.25): Negative PCR results supports immune mediated condition. We are still waiting CSF culture result. Keita reportedimprovement since Monday. She will give me another phone update next week.ADDENDUM (8.12.25): Negative CSF culture rules out bacterial infection to a great degree. Keita reported Haven to becomfortable with expected prednisolone side effects.Medications:Prednisolone 20mg tablets. Give 1 tablet every 12 hours.Gabapentin 300mg capsules. Give 1 capsule every 8 hoursRe-examination: I woos like to re-examine Haven on 30th December or earlier in case of deterioration.

infectious disease testing will help us confirm this diagnosis. This is most likely an immune mediated condition called steroid responsivemeningitis and arteritis (SRMA). It is unknown what triggers the immune system to use this reaction but SRMA is typically seen in dogsof her age with neck pain and pyrexia. Majority of them respond well to steroids as the name suggests but some cases may needongoing steroid treatment to stop having relapses.ADDENDUM (1.12.25): Spinal fluid analysis confirmed inflammation affecting Haven's central nervous system. Pending PCR results willconfirm if this is SRMA or infectious. I have updated Keita with this result. She reported minimal improvement in Haven, which isunusual for SRMA. I have requested CSF culture to be performed as well to rule out all the possibilities. Keita will update me Wednesdaymorning to report on her progress. I would much appreciate it if you could dispense 2 weeks worth of gabapentin as below for Haven.Keita will collect it from you.ADDENDUM (3.12.25): Negative PCR results supports immune mediated condition. We are still waiting CSF cultureresult. Keita reported improvement since Monday. She will give me another phone update next week.Medications:Prednisolone 20mg tablets. Give 1 tablet every 12 hours.Gabapentin 300mg capsules. Give 1 capsule every 8 hoursRe-examination: Phone update on Monday or earlier in case of deterioration.Many thanks for referring Haven to the Neurology & Neurosurgery service at SASH Gold Coast. Please do not hesitate to contact us ifyou have any questions or concerns regarding this case.