C10009030 / invoice 10000

10/03/2026 Consult nurse: 

Reason for presentation: Work up for lymphadenomegaly

History for today:
Ruby presented for further workup of generalised lymphadenomegaly. She started Clavulox over the weekend following a visit on Saturday as a treatment trial prior to working up for possible lymphoma. She has had a mild response to the Clavulox so far and has taken the doses well since Saturday. Today, she has large, generalised lymphadenomegaly. She was sedated with 0.1 medetomidine and 0.4 of 0.58 mL methadone IM, which had a mild sedative effect. She also had pre-meds on board (100 mg trazodone and 600 mg gabapentin) which caused a mild sedative effect. She remained quite anxious with handling, likely due to pain from the lymph nodes. An IV cannula was placed in the left cephalic vein, and 0.1 mL methadone was administered IV. Samples were taken from the right and left pre-scapular lymph nodes, right inguinal lymph node, and both right and left popliteal lymph nodes for cytology and B and T cell immunohistochemistry staining at the Vetnostics lab. A full blood profile was also taken (two serum red top tubes and one purple top tube) to send to Idexx for a total annual health profile. A cystocentesis was also performed.

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:
Clavulox 250mg BID
Trazodone 100mg 2 hours prior to vet
Gabapentin 600mg 2 hours prior to vet

Diet: 

Examination:
Demeanour: BAR, anxious with handling.
Palpate lymph nodes: Generalised lymphadenomegaly. Submandibulars: R 3.5 x 2.5 cm, L 2.5 x 3 cm. Prescaps: R 4.5 x 4.5 cm, L 5.5 x 4.5 cm. Popliteals: R 3.5 x 2.5 cm, L 2.5 x 3 cm.

Assessment: Lymphadenomegaly, ?lymphoma

Treatment:
Sedation with medetomidine and methadone IM.
IV cannula placed in left cephalic vein.
Methadone 0.1 mL IV.
Fine needle aspirates of right and left pre-scapular, right inguinal, and right and left popliteal lymph nodes for cytology and immunohistochemistry.
Full blood profile collected.
Cystocentesis performed.

Next vaccination due: 

Discussion:
Baseline lymph node measurements recorded for future assessment of remission.
Immunohistochemistry/immunocytochemistry recommended on lymph node aspirates.
If results are non-diagnostic, will likely proceed with treatment as for B-cell lymphoma.
With doxorubicin chemotherapy, baseline and ongoing cardiovascular examination is recommended. Echocardiography would be recommended if cardiac concerns are noted on physical examination.

Plan:
Await results of cytology and immunohistochemistry.
Consider starting chemotherapy based on results.

Next revisit: