C10000006 / invoice 10000

07/03/2026 **GAP SUMMARY**

Date: 07/03/26
Assessment: systemic lymphadenomegaly
ddx. lymphoma vs. infection

Treatment:
clavulox BID for 7 dags

Plan:
Recheck Tuesday for FNAs and blood sampling

07/03/2026 Consult nurse: Robbie

Reason for presentation: Swollen neck glands, reverse sneezing and noisy breathing.

History for today:
Both submandibular lymph nodes are enlarged. Reverse sneezing has occurred for 5 consecutive mornings. Kept inside with an air purifier. Last night, developed wheezing on breathing. Bright, alert, and responsive. Eating and drinking normally. Finished course of prednisone. Polyuria and polydipsia noted. Given Telfast (half a tablet) on Thursday and last night. Fasted for consult.

Previous medical/surgical concerns:
20/02/2026: Swelling on left submandibular region - Reactive LN? Unsure inciting cause. Treated with prednisone.
03/2025: Limping LF D4+5. DDx: strain and mild interdigital dermatitis. Treated with Previcox and Neocort.
02/2025: Sedation for FNA of lump on L ear base (dermoid cyst?) and dental scale and polish. Cutaneous mass, 3-4mm, caudal to base of L ear.
04/2024: Conjunctivitis. Treated with Chlorsig.
03/2024: GI disease. Treated with Biome.
02/2024: Kennel Cough. Recommended sedation for future visits.
03/2023: Laparoscopic spay.

Current medications:
nil
Trazodone 100mg - 1 tablet prior to vet visit.
Pregabalin 25mg - 1 capsule prior to vet visit.

Diet: Normal diet.

Examination:
Demeanour: BAR
Eyes: clear
Ears: NAD
Nose and Throat: No abnormalities detected
Mouth/teeth/gums/dental grade: Pink and moist
Resp rate: Lung fields clear
Heart rate: Strong and steady, pulses strong and synchronous
Abdominal palpation: Comfortable and relaxed
Urogenital: No abnormalities detected
Musculoskeletal: Ambulating well but not thoroughly examined
BCS: 4/9
Coat/skin: Healthy
Palpate lymph nodes: Bilateral submandibular lymphadenopathy.

Assessment:
Differential diagnoses include lymphoma, infection, or reactive lymphadenopathy.

Treatment:
Antibiotics prescribed for one week, half a tablet twice daily with food.
Pre-visit medication (Trazodone and Pregabalin) provided for sedation on Tuesday.

Next vaccination due:

Discussion:
Bilateral submandibular lymphadenopathy.
Previous prednisone treatment was effective but symptoms returned after cessation.
Previous FNA was inflammatory, suggesting a local reaction, but current presentation is systemic.
Diagnostic plan for Tuesday includes sedation, lymph node sampling (FNA), full blood panel, and urinalysis.
Pathology will assess for abnormal lymphocytes and perform special staining if indicated.
Potential for lymphoma, which can spread quickly in young dogs.
Cost estimate for Tuesday's procedures is $800-$1150.
Pre-visit medication to be given two hours prior to appointment on Tuesday to reduce stress and sedation requirements.
Keep quiet over the weekend with no excessive exercise.
Monitor for straining to urinate or diarrhoea.

Plan:
Admit for sedation and diagnostics on Tuesday morning.
Procedures to include lymph node sampling, full blood panel, and urinalysis.
Await pathology results to guide further treatment.

Next revisit: Tuesday morning for diagnostics.