C10023221 / invoice 10000

Reason: Recheck + LN palpIntern: JLHistory: Arlo is a 3y 7mo MN Labrador is being managed for multicentric B cell lymphoma with CHOP. CHOP completed 27/2/25. Single agent doxorubicin/mitoxantrone commenced 3/7/25. Multicentric B cell LSA was diagnosed on 6/9, PAX-5 positive, consistent with B cell LSA. He had three weeks history of lymphadenopathy in May'24 and cytology showed lymphoid reactive hyperplasia. In Aug'24, he developed conjunctivitis with sclera eythema. Bilateral hypopyon was detected on 5/9/24. Prednisolone commenced at 20mg PO BID on 5/9/24. CHOP was commenced on 6/9/24. 27/9/24: Doxorubicin was delayed due to grade 1 neutropenia (1.68). He went for a walk in the morning prior to appointment and at presentation, he developed blepharospasm at the left eye initially which then extended to the right eye. Chlorpheniramine and dexamethasone injections were administered. He was discharged home after a day monitoring. Prior to discharge, he passed a large sock with soft stool. 28/10/24: Vinc4/11/24: doxo18/11/24: Vinc2/12/24: Cyclo16/12/24: Vinc30/12/24: Doxo13/1/25: Vinc28/1/25: Cyclo27/2/25: Mitoxantrone - completion of CHOPArlo has remained in CR since completion of CHOP until revisit 5/6/25. Concern for very early enlargement of popliteal LN and reassessment was recommended. 26/6/25: Peripheral lymphadenopathy palpable. FNAB of the R popliteal LN confirmed LSA out of remission. Rescue options discussed. Single agent doxorubicin/mitoxantrone elected in the first instance, with likely rescue with LSPAR and prednisolone. 3/7/25: Single agent doxorubicin commenced and administered @ 30mg/m2. 14/8/25: Switch to single agent mitoxantrone as reached cumulative doxorubicin maximum. 25/9/25: Completed single agent protocol. Arlo has remained in CR since this time. Arlo is presented for reassessment and LN palpation. Arlo has been perfect at home. Small wart-like lesion on right jowel that has decreased in size by 50% since being noted. Examination findings:T: 38.6 C MM: Pink CRT: <2sec  HR: 92bpmRR:  pantPantDemeanour:Weight:41.6 kg - Prev 41.7kgOcular: WNLAural: WNLNasal: WNLOral: WNLCardiovascular: Respiratory: Abdomen: Comfortable on palpation. Integument: Multifocal black pigmented regions dispersed to inguinal region. Small wart-like lesion on the right jowel that is about 2mm and pigmented. MSK: WNL Gait: WNLUrogenital: WNL Neurological: WNL Rectal: NPPeripheral LNs palpate normal (8/1/26) Peripheral LNs palpate normal (12/02/26) Peripheral LNs palpable normal (12/03/26)Laboratory: No diagnostics were performed.Treatment:Fortiflora PO SIDProkolin PRNAssessment:Multicentric B cell LSA - PD 26/6/25, CR currently 16/10/25 Stage V-b, secondary leukaemia and intraocular lymphoma suspectedMild non regenerative anemia- static. CHOP commenced 8/9/24:  - Completed 27/2/25 6/9/24 Vincristine 0.7mg/m213/9/24 cyclophosphamide 248mg/m2 (260mg)27/9/24- week 4 doxo delayed, grade 1 neutropenia day 7 (N: 1.68) post vinc  - PRCHOP protocol completed 27/2/25 - Slightly firm popliteal LNs noted 5/6/25 --> monitor PD 26/6/25 --> out of remissionSingle agent doxorubicin commenced 3/07/25- Induced @ 30mg/m2 IV --> day 7 nadir (10/7/25): NEU 1.27, PLT 132Switch to mitoxantrone 14/8/25 due to cumulative 5 doses of doxorubicin reached. - Induced @ 5.5mg/m2 14/8/25 Single agent protocol completed 25/9/25.--> clinical remission achieved at this time and remains in remission todayAcute onset of hyporexia, diarrhoea - abdo US did not detect ileus or FB obstruction- ddx: primary gastroenteritis - resolvedPertinent:Splenic nodules detected US on 28/1/25Client Communication: Plan:Next revisit in 28 days for reassessment, sooner if concerned. Note: Owner has approved treats    Vital Signs    Weight: 41.6;       MMColour: pink;       Temperature: 38.6;       HeartRate: 92;       RespirationRate: pant;       CRT: 1-2 sec;