C10009824 / invoice 20000

History:Lili presented today for her annual vaccinations. She has been EDUD normally, no v+/d+. She recently has had SRT therapy for a suspect meningioma in the falx cerebri causing seizures and intermittent TL stiffness. See previous entries for full history. She has been well at home, with no new concerns. Current medications:Prednisolone 5mg PO SID (5mg tabs)  Phenobarbitone 30mg PO BID Examination Findings:T: DNT                 MM: Pink, moistP: 108bpm           CRT: 1-2sR: 36bpmDemeanour: BARHydration: Normal. Weight: 11.4kg Body condition score: 5/9Muscle condition score: 3/3. Cardiovascular: WNLRespiratory: WNLAbdomen: WNLPeripheral LNs: WNLOcular: WNLEars: WNLIntegument: Loss of hair pigmentation on dorsal craniumOral exam: WNLMusculoskeletal: WNLGait: WNLNeurological: Full exam not performed. Mentation appropriate. No overt dysfunction. Rectal: NP Laboratory:None. Assessment:Lili presented today for her annual vaccinations. After discussion with neurology department and knowing Lili is currently on prednisolone, her C5 vaccination has been deferred. Her last vaccination was given ~12 months ago, and therefore should still have some coverage. If concerned, titres may be performed. Appropriate to proceed with SR-12. Treatment:SR-12 0.6ml SC (0.05mg/kg)Plan:Defer C5 until off immunosuppressants. Consider tires if concerned.    Vital Signs    

History: Lili is a 7y10m FS miniature schnauzer presenting to neurology for recheck following SRT therapy for a suspect meningioma in the falx cerebri causing seizures and intermittent TL stiffness. See previous entries for full history and PEx.Fed at 0700 with medications.Current medications:- Prednisolone 5mg PO SID (5mg tabs)  - Phenobarbitone 30mg PO BID Neurologic Exam Findings: Mentation/Demeanour -  BARGait and posture - normal gait and postureProprioception - normal paw placement and hoppingMotor function:1.Spinal reflexes - normal2.Muscle bulk - normal3.Muscle tone - normalCranial nerves - normal palpebral, menace, tongue movement, and gagContinence - perineal reflex intactSpinal hyperpathia - nilNociception - conscious reaction to withdrawal reflexOphthalmic exam - no anisocoria, normal PLRNo neurological abnormalities on today's examination.Assessment:Doing very wellPlan:Reduce prednisolone from 5mg to 3.75mg SID as per oncologySubmt blood for trough PHB level, CBC and MBABlood sampled at 1630Lab Findings: 20-2-26    ALT                                  ++       314U/L           (1-80)     Alkaline Phosphatase       +       1028U/L           (1-182)     Albumin                            +         43g/L           (31-42)     Calcium                            +       2.85mmol/L        (2.00-2.80)     Creatine Kinase               +        545U/L          (0-400)    Phenobarbital ( 12.5 mg/L)    54   umol/L   (65-150)    Serum Triglycerides    3.3 mmol/L        (0.2-1.7)Assessment:Mild increase in ALT indicates a hepatopathy, that may be secondary to prednisolone and / or PHB. However the phenobarbitone is subtherapeutic (ie low level is less stimulating to the liver). Similarly, hypertriglyceridaemia is a common sequela to long-term PHB use, and can potentially lead to pancreatitis. With the PHB being below therapeutic range, potentially an increased dose is required, however Lili remains seizure free at present. It is difficult to ascertain the exact magnitude of the drop in PHB as the December levels were done at IDEXX (different reference range). The reduction in PHB from the previous level most likely represents increased metallisation, which could also cause increased hepatic enzymes (ALP). The mild azotemia and hyperalbuminaemia may be due to mild dehydration or increased hepatic metabolism, with increased albumin increasing total Ca. Plan:Continue current medication regime, consider transitioning to a low-fat diet to reduce risk of pancreatitis if TG remain elevated Recheck PHB and bloods in a month's time before repeat MRI.  --- 26/02/2026 17:51:13 CTN: Discussed blood test results with Nerida.Continue as is for now.    Vital Signs    

History: SRT for suspected meningioma at the frontoparietal falx cerebri treated with SRT in December 2025.Lili is going well and bright in herself. Anti seizure medications managed by neurology. She is in for recheck today 2 moths psot completion of SRT. Physical Exam: BARHR:112RR:36T: 37.7MM:pink and moistCRT:<2Ocular: WNL Aural: WNL Nasal: WNL Oral: WNL Cardiovascular: No evidence of murmurs or arrhythmias. Femoral pulses strong and synchronous. Respiratory: Lung sounds clear in all 4 quadrants with no evidence of any crackles or wheezes. Abdomen: Comfortable on palpation. Lymph nodes:peripheral nodes palpate normallyIntegument: leucotrichia dorsal headMSK: WNL Gait: WNL Urogenital: WNL Neurological: WNL Rectal: NP Assessment: Mass lesion - brainMRI and CT: Extra-axial mass centred along the frontoparietal falx cerebri, mostly solid contrast-enhancing tissue with adjacent cystic/CSF-like component with peripheral rim enhancement. DDx falcine cystic meningioma vs less likely meningeallymphoma, histiocytic sarcoma, focal inflam/granulomatous lesion-15/12/25 - RT #1/3 (8Gy x 3 to 24Gy)-17/12/25 - RT #3/3Treatment: Prednisolone reduce to 3.75mg PO SIDPlan: Reassess in 4 weeks and consider reduction to 2.5mg PO SID    Vital Signs    Weight: 11.4;       MMColour: Pink;       Temperature: 37.7;       HeartRate: 112;       BodyScore: 7/9;       RespirationRate: 36;       CRT: <2;