C09993922 / invoice 10000

Reason: History: Examination: Laboratory: Assessment: Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:Diagnosis Other relevant history/comorbidities:Chemo protocol:Treatment number: x/totalHistory since last visit: Less energy since starting palladia, 31.4 (-1.2kg). Water consumption has reduced by almost half. Yesterday soft, day before was normal, but Jigar mentioned that on and off may had diarrhoea. About the same. Still wanting to go walks, still playing. Psyllium husk, 1 tablet ONCE daily,-     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: Was 71 x 60 today 64 x 56 (total)Laboratory:Assessment:Tumour response: Toxicity from previous chemo:Treatment:Medications at home:Next visit:    Vital Signs    

Reason: Bloods + UrineDiagnosis: Metastatic right aprocrine anal sac adenocarcinoma-Prior signs include reported polydipsia (initially noted July 2025) and tenesmus (noted 2 weeks prior)-CT staging (thorax and abdomen) performed via RV with evidence of multiple abdominal lymphadenopathy and mediastinal lymphadenopathy consistent with metastatic disease-Presenting today for bloods, ionised calcium and UA prior to commencing palladia. O reports now seems a bit more lethargic and is seeming to strain to defecate more. O's sister-in-law is referring vet, so are planning to commence laxatives. Current medications: NilExamination: BW: 32.6kg BSA: 1.031m2T: x P: 100 RR: 24 MM colour: Pink, moist CRT: <2s Rectal examination: Externally palpable large right sided mass from 12o'clock to 7o'clock, narrowed lumen on digital palpation with large occluding right sided anal gland mass but improves 3cm in. Occupying approx. 80% width of pelvic canal.  Sublumbar LN L side approx. 11 o’clock approx. 1.5cm x 2cm and then can feel caudal edge of the one cranial to this which is significantly larger. External measurements approx. 71mm x 60mmUrogenital/mammary: NAD MSK: NAD on general exam, full exam not performed Neurological: NAD on general exam, full exam not performed Laboratory: UoM Haematology: White cell count x 109/L 5.9 6.0 – 17.0 LRemainder WNL UoM Biochemisty:Calcium mmol/L 4.21 2.30 – 3.00 HPhosphate mmol/L 0.6 1.0 – 2.6 LBloodgas:ICa 2.20 (1.13-1.33)Remainder WNL Urine General Exam:Specific gravity: 1.005SSA Protein NilAssessment: -Bloods show evidence of hypercalcaemia, given the few month history of polydipsia and hyposthenuria likelihood is that gradual progression has occured in the last few months with probable fluctuating hypercalcaemia. No concerning for renal injury but risk remains present. -Commenced prednisolone for calciuresis however will be guided by response to palladia and may be able to taper off. Alternate therapy (frusemide, bisphosphanates) may be indicated if no improvement noted.Treatment: Palladia 80mg PO EOD (2.45mg/kg EOD) Prednisolone 20mg PO SID x 2 weeks, then 10mg PO SID ongoing until directed otherwisePlan:Recheck in 2 weeks for exam and blood gas.    Vital Signs    Weight: 32.6;       

Consult by Dr Nevin SinghReason: Right Anal Gland CarcinomaHistory:-10/02/26 – Presented to RV following 2 week history of tenesmus. Examination noted a large mass on the right perianal region. FNAs (Vetnostic) returned as apocrine carcinoma of the anal sac. -12/02/26 – Underwent CT (chest and abdo with contrast), images submitted to Southern Vet Imaging for CT interpretation. Findings:-Right perineal mass (6cm x 8cm x 6.9cm) consistent with known apocrine gland anal sac adenocarcinoma (AGASCA) with extensive regional (intrapelvic, sublumbar, inguinal) lymph node metastasis resulting in occlusion of the caudal vena cava and secondary femoral vein thrombi bilaterally. There is direct invasion of the colonic/rectal lumen as well as involvement of the perineal vasculature within the mass.– Mediastinal lymphadenopathy. Presumed metastatic from the anal gland neoplasia.– Transitional lumbosacral vertebra with secondary degenerative changes and disc bulging.– Incidental left C7 cervical rib (partial)– Incidental duplicate gallbladder.– Left iliopsoas insertional enthesiopathy.– Bilateral supraspinatus enthesiopathy and suspected left tenosynovitis.– Multifocal paraspinal intravascular gas. Most likely incidental iatrogenic.O reports that prior to this, Sirius has been relatively healthy with no pertinent medical history. July last year O noted increased water consumption, initial investigation by RV noted mild hypercalcaemia, O reports rectal at this time by RV did not identify any concerning anal gland findings. USG 1.003. O reports this has been ongoing, but when quantified they are maybe only filling up the water bowl one extra time at best. No polyuria reported. He has been eating well, and has normal activity (playing with other dog at home, playing at the dog park and beach as per usual). His current diet is a wet food based diet which he has been eating well, and he is UTD with prophylaxis.O reports no increase in defecation frequency, however when Sirius does try to defecate he strains for longer. This is not a consistent findings, and yesterday he did a normal defecation. He is not straining unproductively and the faeces appear normal shaped. Pertinent medical history:-R flank 2.5cm x 4cm mass -> previously aspirated as lipoma by RV in Feb 2024 -R TPLO June 2024-Required emesis following Christmas cake ingestion Dec 2025. Follow up bloods (ASAP) 27/12 noted mild haemoconcentration HCT 0.57 (0.37-0.55), mild lymphocyte activation and mild hyperproteinaemia 76 (53-73) with hyperglobulinaemia 41 (23-38).-Mild hypercalcaemia reportedly noted on bloods in July 2025 during investigation of increased water consumption, but normal on more recent bloods in Dec 2025 (blood results not available at time of writing consult notes)Current medications:NilPhysical examination:Weight 33.0kgBCS: 5/9T: x  P: 108  RR: 20  MM colour: Pink, moist CRT: <2sEyes: NADEars: NADNose: NADOral: NADLymph nodes: NADIntegument: Palpable SQ mass on R flankRespiratory: NADCardiac: NADAbdominal palpation: Soft and comfortable, no obvious organomegaly palpable Rectal examination: Externally palpable large right sided mass from 12o'clock to 7o'clock, narrowed lumen on digital palpation with large occluding right sided anal gland mass but improves 2-3cm in. Unable to palpate sublumbar lymphadenopathy (examiner limitations). 3cm subcutaneous mass right flank, firm Urogenital/mammary: NADMSK: NAD on  general exam, full exam not performed Neurological: NAD on general exam, full exam not performed Laboratory: NoneAssessment:Sirius has likely stage 4 disease (primary tumour >2.5cm, regional LN – no measurements but given description likely >4cm, presumed metastatic mediastinal LN). The following options were discussed in length, all with goals of controlling local and metastatic progression:1.Surgery: Not curative, only for debulking primary tumour and regional LNs if causing significant impact on QOL but unlikely to change outcomes. Surgery is associated with significant risks given proximity to vasculature with concern for haemorrhage. Not likely an option for Sirius given  reported colonic/rectal luminal invasion.2. Radiation (primary mass and sublumbar LNs): Hypofractionated vs SRT, would require consultation with radiation oncologist to determine most appropriate protocol. Can be associated with short term effects such as colitis and long term side effects such as stricture formation. Will need some form of adjuvant treatment for managing metastatic disease. 3. Chemotherapy: -Carboplatin: Reported 33% PR (stage 4 disease), overall unknown benefit with gross disease and metastatic disease. -Palladia: Reported to have clinical benefits (in face of macroscopic disease setting), with reported 20-25% PR with 45-50% maintaining SD for months.-Consider combination therapy of carboplatin + palladia4. NSAID:-COX2 expression documented in AGASACA, use of COX2 inhibitors (meloxicam) will likely provide benefit with regards to tumour associated discomfort as well. Treatment:NonePlan:Os to consider options and let us know if interested in pursuing a teleconsultation with a radiation oncologist. Discharge information and chemotherapy safety handout sent. Client communication:-Discussed extensively options discussed in assessment and potential side effects of each options.-Discussed chemotherapy safety, Os have young children and this is a concern for them.-Discussed variation of radiation protocols pending radiation oncology recommendations (SRT vs weekly hypofractionated vs daily hypofractionated over 1-2 weeks). Only available in Sydney, with costs $10000-15000 pending protocol. -Discussed things to monitor for when assessing disease progression and QOL. -Os will consider options, sister-in-law is referring vet. If interested in radiation, can consider organising a telehealth consultation with radiation oncologists in Sydney.-Use of laxatives discussed, currently not indicated based on Os description. If concurrent use of meloxicam and laxative pursued, close monitoring for melena, haematochezia and vomiting recommended.    Vital Signs    Weight: 33.0;