C09996657 / invoice 10000

06/03/2026 Diagnosis: Osteosarcoma right distal femur; CT staging (clear; osteomas noted); amputation + carboplatin #4/4 

History: Daisy has been well over the last 1.5 weeks.  She continues to have GI side effects after each carboplatin treatment, in particular there is 4-5 days of Daisy being uninterested in food; and she has more accidents inside (urinary).  It takes about 1 - 1.5 weeks for her to return to normal.  Currently she is bright and happy, keen for walks and her appetite, thirst, toileting and energy levels remain normal.  There are no other concerns with Daisy.  We discussed a dose reduction and her family are OK with the current dose as they feel her side effects are manageable.  They have also elected to finish chemotherapy after this 4th dose.  

Physical Examination findings: Bright, alert and responsive.
Mm pink, crt < 2 secs, HR 120, RR 28, Temp 38.5, Wt: 11kg 
Oral exam: mild to moderate tartar.  All peripheral nodes within normal.  Heart & lungs normal.  Abdominal palpation unremarkable.  Amputation site palpates normally.  No new concerns on examination. 

Laboratory results: CBC performed in house with manual blood film assessment.
Hct: 0.486
WCC: 6
Neuts: 2.7- 4.2
Platelets: 498

Manual differential count:  Neutrophils 70%, Lymphocytes 30%, Monocytes 0%, Eosinophils 0%.
Platelets: clumped and adequate
Morphology: Normal 

NSAID panel: AST 70; all other parameters normal.  

Procedures: Sedation: Domitor (5mcg/kg), butorphanol (0.2mg/kg) IV; later reversed with antisedan IM (equal volume). 
Three view thoracic radiographs: There are several very small, mineralised pin point lesions throughout the pulmonary parenchyma; DDx osteoma versus early metastases.  On review of the CT scan these were also present at this time; whilst it's difficult to compare between different imaging modalities; it's less concerning given they were present at diagnosis.  

Discussed options of:
- Send images to a radiologist (still may not give a definitive answer
- Repeat imaging, ideally with CT in 1-2 months.  

We elected to proceed with treatment today and repeat a CT scan in 1-2 months.  

Treatment: 110mg carboplatin (10mg/kg ~220mg/m2) was administered IV via a 22g catheter in the left medial saphenous vein using the closed injection Equashield system.
1mg/kg maropitant administered IV immediately prior to chemotherapy
Medications associated with Daisy's visit:
- Ondansetron (Zofran) Wafers 4mg x 10.00
   Give 1 wafer twice daily - as required for vomiting, nausea and/or inappetence. Will dissolve in mouth. Does not need to be swallowed.

Comments:  We will see Daisy again in 1-2 months for her post chemotherapy revisit and likely CT scan.  Please feel free to call or email if you have any further queries regarding Daisy.