C10009544 / invoice 10000

Rectal temp 38.2C
No vomiting.
Pink mucosa. Mucosa a bit dry and sticky but not panting.
Diarrhoea managed.
Concern about prune pit consumed. Could it cause a blockage?
Femoral pulses strong. HR 58bpm.

	Referral Letter for Billie Silva	

	Patient Details:	
	Name:		Billie	
	
Description:


Age:
		Female Desexed Black With White Greyhound Cross	
			12 Years	
		
	Owner:		Ms Jules Silva	

	195 Wood Sreet, Preston Victoria 3072 - 0407661994	

	Date:	February 16, 2026	

	Thanks for the referral of Billie Silva. Please find details of Billie's recent visit to our practice below.	

			
Notes:		23/02/2026	
	Diagnosis: Multicentric B cell lymphoma, stage III+ (poss stage V atypical circulating lymphs), substage a diagnosed 10/12/25

Chemotherapy protocol: CHOP
Response to treatment: strong partial/complete remission
Treatment due: Doxorubicin
Treatment number: 8/16
Side effects last chemo: none
Protocol modifications:
- monitor diarrhoea secondary to vincristine
-15% dose reduction doxorubicin due to grade 2 diarrhoea and grade 1 hyporexia
Restaging/monitoring plan: Monitor PLN, perform FBE, chemistry + urinalysis today and 16th treatment
Other medical history/co-morbidities:
- Atopy (grass allergy) – desensitisation therapy MVSC derm 2017/18 minimal response per O, responds well to cytopoint (not currently receiving)
History since last visit: Billie has been very well at home, EDDU normally. There are no new concerns.

Current diet: dry food, cooked egg, sardines/tuna
Current medications:
- Prokolin, smectite and ondansetron following GI AEs, none since 26/1

Physical Examination findings:
Demeanour: BAR
Body condition score 5/9 good
MM pink, CRT< 2 secs, HR 128, RR 32, Temp 38.6C  Wt: 26.6kg BSA: 0.9m2
Oral: brief exam no major concerns
Eyes: no concerns noted
Ears: no concerns noted
Nose: no concerns noted
Integument: Haired firm cutaneous mass approx 5-6mm R tarsal region, unchanged. Firm SQ mass over L hip (likely has been present but not noted earlier) approx 10mm. Soft SQ mobile mass L ventrolateral abdomen (new)
Lymph nodes: lymph nodes largely palpate normally , for reference:
- L SMLN 9mm prominent, R SMLN 10mm prominent - still palpate firmer/not normal
- L + R PSLN <10mm max diameter palpably normal
- L pop 8mm;  R pop 9mm normal
Inguinal and axillary not palpable
Attempted aspirate of mandibular LNs - R side largely fat + blood. L side scant lymphoid tissue obtained.
Cardiovascular: no murmur on auscultation, pulses strong and synchronous
Respiratory: normal bronchovesicular sounds bilaterally, normal rate and effort
Abdomen: no fluid or masses on palpation, soft and comfortable
Rectal: no internal lymphadenopathy, soft stool on glove
Musculoskeletal: ambulatory x 4, normal gait, full MSK exam not performed
Neurological: no abnormalities noted, full neurological exam not performed

Laboratory:
Hct: 0.422
WCC: 4.34
Neuts: 2.53
Platelets: 305

Manual assessment: neutrophils 71%, monocytes 6%, lymphocytes 19% eosinophil: 4%
Platelets: clumped and adequate
Morphology: normal

Pathologist blood smear review to assess for atypical circulating cells.
Chemistry  unremarkable
Urinalysis pending.

Aspirates of L + R mandibular nodes. Non-diagnostic R side. Scant lymphoid tissue L side but clear mixed population of small and int lymphs, not consistent with lymphoma.

Assessment:
- Multicentric B cell lymphoma, stage V substage a - complete remission (pending FBE results)
- Grade 1 neutropenia
- OK for chemotherapy

Treatment:
Doxorubicin 25.5mg/m2 (15% dose reduction) = 22.9mg (11.4mL) administered slow IV over 20 minutes with saline in the right cephalic vein.

At home medications:
- Maropitant 60mg PO SID next 4 days starting today
- Ondansetron 16mg PO BID-TID PRN nausea
- if diarrhoea develops, smectite 4.3g PO TID (1 1/3rd sachet Diarrh-relieve)

Client communication: We are very pleased that Billie appears to be in a complete remission. We discussed the dose reduction of doxorubicin today to reduce the risk of severe diarrhoea and hyporexia, and advised on prophylactic medications. We also advised that limited lymphoid sample was obtained today but what was visible indicated reactive/normal LNs. Further, typically neoplastic LNs readily shed neoplastic cells, meaning a reactive process is even more likely. Billie's owner was very happy with the results and plan.

Next visit: 2/3/26 for CBC nadir
Next chemotherapy visit: due 9/3/26 however due to PH will need to be delayed until 10/3/26 for CBC + vincristine

Referral Letter for Billie Silva	

Patient Details:	
Name:		Billie	

Description:


Age:
		Female Desexed Black With White Greyhound Cross	
		12 Years	
		
Owner:		Ms Jules Silva	

	195 Wood Sreet, Preston Victoria 3072 - 0407661994	

Date:	February 16, 2026	

Thanks for the referral of Billie Silva. Please find details of Billie's recent visit to our practice below.	

Notes:		16/02/2026	
Diagnosis: Multicentric B cell lymphoma, stage III+ (poss stage V atypical circulating lymphs), substage a diagnosed 10/12/25

Chemotherapy protocol: CHOP
Response to treatment: strong partial/complete remission
Treatment due: vincristine
Treatment number: 7/16
Side effects last chemo: none
Protocol modifications:
- monitor diarrhoea secondary to vincristine
- 10% dose reduction doxorubicin due to grade 2 diarrhoea and grade 1 hyporexia
Restaging/monitoring plan: Monitor PLN, perform FBE, chemistry + urinalysis 8th and 16th treatments
Other medical history/co-morbidities:
- Atopy (grass allergy) – desensitisation therapy MVSC derm 2017/18 minimal response per O, responds well to cytopoint (not currently receiving)
History since last visit: Billie has been very well at home, EDDU normally. There are no new concerns.

Current diet: dry food, cooked egg, sardines/tuna
Current medications:
- Prokolin, smectite and ondansetron following GI AEs, none since 26/1

Physical Examination findings:
Demeanour: BAR
Body condition score 5/9 good
MM pink, CRT< 2 secs, HR 128, RR 40 (anxious), Temp 38.1C  Wt: 25.5kg BSA: 0.875m2
Oral: brief exam no major concerns
Eyes: no concerns noted
Ears: no concerns noted
Nose: no concerns noted
Integument: Haired firm cutaneous mass approx 5-6mm R tarsal region, unchanged. Firm SQ mass over L hip (likely has been present but not noted earlier) approx 10mm.
Lymph nodes: lymph nodes largely palpate normally , for reference:
- L SMLN 9mm prominent, R SMLN 10mm prominent - still palpate firmer/not normal - plan to sample next visit INI
- L + R PSLN <10mm max diameter palpably normal
- L pop 8mm;  R pop 9mm normal
Inguinal and axillary not palpable
Cardiovascular: no murmur on auscultation, pulses strong and synchronous
Respiratory: normal bronchovesicular sounds bilaterally, normal rate and effort
Abdomen: no fluid or masses on palpation, soft and comfortable
Rectal: NE
Musculoskeletal: ambulatory x 4, normal gait, full MSK exam not performed
Neurological: no abnormalities noted, full neurological exam not performed

Laboratory:
Hct: 0.43
WCC: 8.11
Neuts: 5.73
Platelets: 339

Manual assessment: neutrophils 77%, monocytes 4%, lymphocytes 7% eosinophil: 12%
Platelets: clumped and adequate
Morphology: normal

Assessment:
- Multicentric B cell lymphoma, stage V substage a - strong partial/complete remission
- OK for chemotherapy

Treatment:
Vincristine 0.67mg/m2 (rounded down, same dose as prev) = 0.59mg (0.59mL) administered IV in the left cephalic vein.

At home medications:
- Ondansetron 16mg PO BID-TID PRN nausea
- if diarrhoea develops, smectite 4.3g PO TID (1 1/3rd sachet Diarrh-relieve)

Client communication: We discussed how pleased we were Billie is tolerating treatment well. Given Billie's mandibular LNs remain prominent, we will sample these next week (halfway point) to ensure they are just reactive and do not contain lymphoma. We will see Billie in 1 week for her next chemotherapy treatment

Next chemotherapy visit: 23/2/26 for CBC + chemistry + urinalysis +/- SMLN sampling + doxorubicin if all going well