C09996157 / invoice 10000

06/03/2026 Diagnosis:Intermediate to large B cell lymphoma (flow cytometry). 5 months post last chemotherapy treatment; 9 months post diagnosis; Restart CHOP (relapsed) week 8 Vincristine.

History: Pepper has been in good health. Paul reported Pepper been ravenous, waking up overnight for food, he also noticed some episodes of fatigue. Toileting habits remain normal.

Physical Examination findings: Bright, alert and responsive (anxious)
Oral; mild periodontal disease
Heart Lungs: no murmur or arrhythmia, tachycardic, most likely due to stress; normal respiratory effort and bronchovesicular sound bilaterally 
Abdomen: slightly tense on palpation but not painful
Rectal: unremarkable
Lymph node: no lymphadenopathy
Integ: no lesions, wounds and ectoparasites noted 
Mm pink, crt < 2 secs, HR 184 , RR pant, Temp 39.2, Wt: 9

Laboratory results: CBC performed in house with manual blood film assessment.
Hct: 0.507
WCC: 3.21
Neuts:1.67 (2.0 on blood smear)
Platelets: 413

Manual differential count:  Neutrophils 64%, Lymphocytes 19%, Monocytes 17%, Eosinophils 0%.
Platelets: clumped and adequate
Morphology: Normal 

Treatment: 0.28mg vincristine (0.7mg/m2) was administered IV via a 22g catheter in the left lateral saphenous vein using the closed injection Equashield system.
1mg/kg maropitant administered IV immediately prior to chemotherapy
Reduce prednisolone to 5mg PO EOD for one week then twice a week for one week and stop

Comments: It was a pleasure to see Pepper today. We will see Pepper again in 1 weeks' time.  Please feel free to call or email if you have any further queries regarding Pepper.