C10003916 / invoice 10000

Euthanasia - 7/3/26
** there will be a small discount on file as owner didn't need to pick up meds from SB that were already paid for (decided to euth today)
2-5
Burbank
A&N Confirmed

Following on from yesterdays visit O's have decided time to say goodbye.

Home burial

Euthanasia at owners request due to underlying cancer.
Iv catheter placed L cephalic vein followed by thiopentone then pentobarbitone administered via catheter. 


After Care: 
Owner has elected for home burial

11-2
v+ and off food, O wants an anti nausea inj, Charlie won't come inside 
VSS underwood patient for cancer

Subjective:
Charlie had several flank low grade MCTs removed in 2024, with evidence of spread to L prescap LN, and had course of Vinblastine, and went into remission. In 2025 had new lumps, which were removed, showed high grade MCT, and evidence of spread to local LNs. Started a second course of Vinblastine, and they were at infusion 13/14, and sadly new MCTs were continuing to emerge. Decision was made to stop chemo and transition to palliative care with Palladia.

Was on Palladia for a month, then developed severe vomiting, and was really miserable. Owners decided to stop the medication because her QOL on it was not worth the improvement in 'longevity'. 3 days after stopping Palladia, she was happy, lively, running around like her old self.
Weaned off the Pred at the same time. 

Is not on any medication at present. Owner still has unused Omeprazole, Pred, Cerenia, Zyrtec at home. Not on any pain relief.

2 days ago she started not wanting to eat as much, getting lethargic. The lumps on her dorsum have significantly increased in number and size. 
Last night, Charlie woke up at 1.30am, and went outside nad just laid on the grass in the rain. Owner went outside to check her, and found her gums and ears were flushed red, and in between her legs, too.

Is vomiting. Sometimes close to drinking, sometimes not associated iwth drinking. Not wanting to eat anything and they have tried all the usual treats.
No diarrhoea. Normal poo passed yesterday evening. Didn't look black.

Objective:
T40.6C , PR112 , RRpanting , MM injected, CRT <1s
Body condition: 4/9
Thoracic auscultation: No murmur or arrythmia, respiratory rate and effort WNLs, no adventitial sounds, no wheezing or crackles
Abdominal palpation: Soft and non-painful, no distension or fluid wave
Eyes: sclera injected, Clear, no discharge. Pupils even with normal PLRs and menace.
Ears: no discharge. Pinnae are flushed
Mouth: tongue has two 5mm lesions on dorsal surface.  ventral to RHS commisure lip has a 12mm erosive erythematous lump
Integument: 12cm firm mass dorsal RHS thoracic flank, surrounded by 8 smaller erythematous hairless riased firm lumps ranging fom 9mm to 15mm in size.  
Musculoskeletal: Ambulatory, stiff gait, tires easily
Neurological: BAR, cranial nerves WNLs
Rectal exam: Not performed

Assessment:
1/ Vomiting - combination of degranulation syndrome, pain, pyrexia, possible GI ulceration or tumour involvement, cachexia, or possible heaptic/renal mets
2/ Metastatic MCTs - she is entering end stage terminal cancer, I fear
3/ Injected MMs - likely from pyrexia, degranulation syndrome, pain

Plan:
sDiscussed her QOL. Discussed her prognosis as grave at this point.
Our focus must be on trying to manage her CSx, and if we can't do that successfully, euthanasia.
Owner is very much on the same page, but wants to try and see if she can be helped.

Buprenorphine 0.9mL SC @ 3pm, then PO BID.  Only had enough to get through until tomorrow morning. Make up more doses for owner to collect from clinic tomorrow.
Prevomax 2.5mL SC @ 3pm, then remaining tablet given at 3pm tomorrow
Zyrtec 10mg PO BID
Ondansetron 8mg PO BID - dispensed 12, but only had 10 in van. Need to put another 2 tablets aside in clinic.


On Sunday, if inappetance and vomiting have continued, trial Pred 10mg PO BID, then Metronidazole 300mg PO BID.
Discussed CBC bloodwork and biochem to look at liver and kidney function.  Discussed IVFT and active cooling, though if cachexia, unlikely to help.

If no improvement by Monday, euth.

If she has improved on pain relife, anti-histamines and anti-emetics, consider putting her on a Fentanyl patch, so owner doesn't have to give som much medication by mouth.
Told owner about empty gelatine capsules - might help reduce medication taste during tabletting, and make it just a tad less unpleasant for her.

VSS underwood history