C09998674 / invoice 10000

06/03/2026 HISTORY
Presenting for: Alfie presented for review of medications for meningoencephalitis and optic neuritis management.
Historical Conditions: Meningoencephalitis currently being managed. Blindness in right eye due to optic neuritis. Retains vision in left eye. Prednisolone dose reduction was due in February but was skipped as owner was away. Was due for review with Doctor Jonathan at Perth Animal Eye Hospital but he is unavailable and no appointments available for several weeks.
Current Meds: Prednisolone 5mg SID (one 5mg tablet). Cyclosporine 15mg BID (0.15mL of 100mg/mL solution).

EXAM
Mentation: BAR - can bite 
Wt: 5kg (gained 400g)
HR: 140
Behavioural: Super happy to take treats. Can get snappy with exams, examined gently.
Eyes: Absent menace response on right side, present on left. Cloudiness to lenses bilaterally. No redness, discharge or blepharospasm.
Cardiovascular: No audible murmur.
Abdominal: Gentle palpation nonreactive. No significant pot belly.
Integumentary: Coat remains sparse down dorsum with pigmentation consistent with iatrogenic hyperadrenocorticism from steroids.

ASSESSMENT
Meningoencephalitis - stable on current therapy but overdue for prednisolone weaning as planned
Iatrogenic hyperadrenocorticism - secondary to chronic steroid therapy

PLAN
Changes to Existing Meds/Tx:
- Reduce prednisolone to 4mg SID,  using 1mg tablets (on order for Monday). 
- Continue cyclosporine 15mg BID (0.15mL of 100mg/mL solution)
- Dispensed additional 5mg prednisolone tablets to cover weekend until 1mg tablets arrive

Additional Discussion:
- Owner has half bottle (50mL) of Neoral solution remaining which should last for full weaning process
- Will check with Doctor Tebb regarding need for cyclosporine blood level monitoring
- Telemedicine appointment option discussed for 4-week recheck if stable

Plan is to wean by 1mg of pred every month and then when down to 1mg will do this for a month and then eod for a month then STOP. Cyclosporin stays the same until the pred has been weaned to 1mg eod for a month and stopped, then we wean cyclosporin to 10mg BID for 4 weeks then 5mg BID for 4 weeks then stop. 


Good afternoon, 
We are managing "Alfie" Lau's medication weaning for his meningo-encephalitis or unknown origin and optic neuritis. 
We have a clear weaning plan documented from Dr Tebb. Alfie is currently stable and well (albeit looks a bit cushingoid!). 
The owner was away in Feb so we have just weaned Alfie from 5mg to 4mg SID prednisolone. Cyclosporin 15mg BID continues. 
I wanted to check if we are meant to be checking cyclosporine levels and if so what's the target range? 
Kind regards, 
Dr Nicole Leslie