C10004205 / invoice 10000

Reason: RecheckIntern: SNHistory:Jasmine is presented today for reassessment of her peripheral lymphadenopathy +/- adjustment of prednisolone dosing. Jasmine has a history of extensive gastrointestinal & dermatologic signs, which have been present since a young age. Owners have trialled several diets, antimicrobials & supplementations. Her most successful combination appears to Hills Z/D, maropitant & cobalamin/fortiflora supplementation. She was lost to follow up from 2024 until June 2025, with vet visits usually minimised due to severe anxiety and aggression whilst in clinic. At a recheck on 17/2/26, OR that Jasmine was generally well at home with no gastrointestinal or dermatological signs, vomiting or diarrhoea noted. O’s noticed swellings in the region of the chest/scapulae bilaterally over an unknown period. Snoring like sounds and slightly raspy breathing was noted in the days prior to this recheck, with no other respiratory signs. Sedated PEx showed marked peripheral lymphadenopathy of the submandibular LN’s, prescapular LN’s, inguinal LN’s and popliteal LN’s on palpation. Lymph node FNAB returned consistent with large cell lymphoma, and external CBC concerning for early leukaemic change. No overt thoracic lymphadenopathy was noted on CxR. Palliation with steroid therapy was commenced. At her last recheck (25/2), OR that Jasmine was NQR following her previous visit, but her demeanour was significantly improved. Lymph nodes were subjectively smaller and resolution in the noisy breathing/snoring had been noted since prednisolone was commenced, and mild polydipsia noted. Jasmine was eating well and very bright at home. Only new concern was erythema of her ventral abdomen, suspected to be clipper rash post-ultrasound. Today, ##############Diet: Hills Z/D (dry + wet)Other medical hx:- OA/DJD: intolerant to supplementation - Allergic dermatitis / otitis externa: managed on Apoquel, Neocort & antimicrobial courses as required- Aggression: trazodone and gabapentin prior to vet visits, however, requires muzzling Current medications: - Trazodone 300mg PO day before and 90-120 minutes prior to appointment- Gabapentin 600mg PO day before and 90-120 minutes prior to appointment- Metoclopramide 10mg PO TID- Cobalamin 2000ug PO SID - PMP ear suspension 0.5ml bilaterally BID - discontinued by O- Dermcare otoflush/PAW by Blackmores - discontinued by O- Maropitant 80mg PO SID (not been using)- Psyllium husk 1tsp SID (advised but rarely using)- Prednisolone 40mg PO SIDExamination Findings:Tolerated very limited physical examination outside.Demeanour: BAR, occasional growling when approached - ##### Subjective mild improvement in size of pre-scapular lymph nodes - subjectively 50% reduction - ##### Generalised irregular patches of erythema of clipped region of the ventral abdomenWeight: ######### 46.0kg (-1kg) BCS: 7/9MCS: 2/3Laboratory:None performed. Assessment:Problem List:- Generalised severe peripheral lymphadenopathy - large cell lymphoma- Non-specific URT noise/cough - resolved - Chronic enteropathy - currently well managed- Nocturnal restlessness/eructation (well managed)- Chronic recurrent/refractory otitis externa (bilateral infection currently present) - Previous ocular lesions (not reassessed) - Previous hypercholesterolaemia (not reassessed) #######################Treatment:Continue: - Prednisolone 40g PO SID - Trazodone 300mg PO Day before and 90-120 minutes prior to appointment- Gabapentin 600mg PO Day before and 90-120 minutes prior to appointment- Metoclopramide 10mg PO TID- Cobalamin 2000ug PO SID - Maropitant 80mg PO SID (not been using)- Psyllium husk 1tsp SID (advised but rarely using)Plan:#########################    Vital Signs