C10020155 / invoice 10000

Reason: Recheck IMTPIntern: TB DRAFT History: Ally has been managed by IM for IMTP (diagnosed October 2024). Ally was initially commenced on prednisolone & cyclosporine, then later with switched to prednisolone & azathioprine. After subsequent tapering, she has had intermittent relapses. - 1/5/25: Ally had a reduction in platelet count, at which point prednisolone was increased. In herself, Ally had continued to do well. - 24/06/25: prednisolone was discontinued. Azathioprine was continued at 10mg PO EOD.- 10/07/25: doing well since the discontinuation of her prednisolone. She had lost weight (intentional) and her platelets were clumped on external haematology.  Azathioprine was continued at 10mg PO EOD for another week, and then reduced to twice weekly. - 05/08/25: Came out of remission with reduced platelet counts on smear (unable to measure true count due to clumping). Prednisolone was recommenced at 2.5mg SID, azathioprine continued 10mg EOD. ** Owner noted that just prior to last blood test on 3/8/25, Ally was administered her normal Simparica trio; owner was wondering whether this could have contributed to her recent relapse. She has otherwise been well, EDDU normally, no vomiting or diarrhoea. - 28/8/25: Ally doing well, reduced prednisolone to 2.5mg EOD, continued azathioprine 10mg EOD. - 09/09/25: Ally doing well however thrombocytopenia had relapsed. Increased Prednisolone 2.5mg SID. - 10/10/25: Ally doing well. Adequate platelets. No change to prednisolone or azathioprine, commenced trazodone prior to veterinary visits. - 8/12/25: Ally doing well. Adequate platelets, ALT mildly elevated (107), ALKP mildly elevated (334). No change to prednisolone or azathioprine dosing. Today (12/03/26), Owner reports Ally has been XXXDiet: Diet: Chicken & cooked chicken/roo mince with pumpkin, SP and carrot. Psyllium added into diet. Current Medications:- Azathioprine 10mg PO EOD - Prednisolone 2.5mg PO SID - Trazodone 50mg PO 2 hours prior to vet visitExamination Findings: T: 38.7  C                     MM: Pink, moist P: 144 bpm                  CRT: <2 sec R: 24 bpmDemeanour: BAR, anxious Hydration: Euhydrated Weight: 12.1 - inc againBody Condition Score: 8/9 Muscle Condition Score: 3/3 Cardiovascular: WNL Respiratory: WNL Abdomen: WNLPeripheral LNs: WNL Ocular: WNL Ears: WNL Integument: WNL Oral exam: mild periodontal disease 2/4  Musculoskeletal: WNL Gait: WNL Neurological: Full exam deferred, mentation appropriateRectal: Not performed Laboratory: QML Non-Interpreted Canine Profile -> see attachedCBC: adequate platelets, nsf otherMBA:ALT + 107 U/L (1-80)Alkaline Phosphatase + 334 U/L (1-182)Amy/Iip/TT4 - wnlProblem List: - IMTP (diagnosed October 2024)- Obesity (improving)- Mild elevations in ALT and ALP- Anxiety Assessment: Ally remains clinically well. She has historically not tolerated dose reduction of prednisolone, with recurrence of thrombocytopaneia (without clinical signs associated) when under 2.5mg/day.  Today platelets are adequate, Mild elevation in ALT and ALP could be related to the steroids or azathioprine. Ongoing monitoring advised as only mild elevations and clinically well.Slow tapering of her prednisolone may be possible, however ongoing reassessment will be required due to the risk of recurrence of IMTP/thrombocytopaenia. It is possible that Ally will require life-long low dose prednisolone. Plan: - Azathioprine 10mg PO EOD - Prednisolone 2.5mg PO SID - Trazodone 50mg PO 2 hours prior to vet visit- Recheck in 2-3 months unless concerns before that.    Vital Signs