C10024894 / invoice 10000

Over the past two weeks, Neo has exhibited episodes of pollakiuria. Initially, there was a normal urinary stream, followed by dribbles urine. I recommend repeating urinalysis, as dogs with bladder masses are at risk for recurrent urinary tract infections. An appointment with oncology will be scheduled to repeat the bladder scan.

Diagnosis: Urothelial carcinoma; surgically resected Aug 2025 (incomplete margins, lymphatic invasion and high MC); adjuvant NSAIDs/ chemotherapy.  Staging; no overt metastases. Mitoxantrone # 2 doses then progressive disease; change to vinblastine #5 doses; currently on chlorambucil tablets.  

History: Neo has been very well. His appetite, thirst, toileting and energy levels remain normal.  There are no new concerns with Neo. 
He has been leaking urine after the main urination of the day (first thing) and also when lying down and at other times; Neo seems unaware of this.  There is no blood in the urine or straining to urinate.  Neo is playful and otherwise very happy.  On walks still stops frequently to try to urinate and the first urination of the day is normal.
Neo has had the best 2 months since starting treatment and has an excellent quality of life.  He is back to being able to walk 7-8km on Sunday.  Other than the urinary incontinence he has been very well.  

Physical Examination findings under sedation: Quiet, alert and responsive.
Oral: unable to exam, requires to be muzzle 
Heart&Lungs: no murmur or arrthymia noted on auscultation. Normal respiratory rate and bronchovesicular sound bilaterally 
Abdomen; soft and comfortable.
Rectal: no internal lymphadenopathy, normal faecal material and lining
LN:no lymphadenopathy 
Integ; glossy and clean coat. No lesions or wounds noted.
Mm pink, crt < 2 secs, HR 108, RR 36, Temp 38.5, Wt: 25.4kg 

Bladder US findings (urinary ultrasound): 
Previously noted bladder lesions have coalesced into one larger mass measuring 2.85 x 4.68cm (was apical lesion-  3.9 x 1.8cm; mid body lesion- 1.7 x 5.8cm and trigone 1.6 x 1.77cm. The area was 15.65cm2 (was 11.99cm) and C= 17.9cm (was 24.43cm). From the right the bladder mass measured 3.2 x 7cm (was 2.7 x 4cm).  
- Only the right ureters was mildly enlarged today (was bilateral); measuring 0.62cm (was 0.5cm).  There was also evidence of renal pelvic dilation of the right only (previously bilateral with the left only mild previously and normal today).  The right renal pelvis measured 3.3 x 6.1cm (was 1.8 x 3.54cm); there was only a thin rim of renal cortical tissue present.   
-  MILN enlarged bilaterally today; The right MILN measured 2.3 x 4.5cm (was 1 x 2.3cm); the left measured 1.3 x 3.4cm (was 0.6 x 2.4cm).  

Conclusion: Difficult to accurately compare with ultrasound; bladder mass stable disease with no left sided hydroureter and moderate on the right side (renal pelvic dilation). 
- Progression in size of the medial iliac nodes.  

Laboratory results: 
Haematology: mild lymphopenia (*0.5 x10^9/L ( 0.9 - 4.1 );no other concerns
Biochemistry: 
Creat 260 was 262 (previously 247); ULN 117
Urea 25.1 was 23.8 (previuouly 25); ULN 9.2; 
No other concerns; renal levels stable.  

Treatment: Chorambucil 2mg.  
Give 2 tablets once daily from Mon to Sat with no tablets on Sundays 
CYTOTOXIC – Wear gloves and wash hands afterwards, do not break or split tablets. Keep refrigerated.
-Ondansentron 8mg as required
- Turkey tail 
- CBD oil (Vet prescription)

Sedation prior vet appointment:
Gabapentin 300mg PO   2h prior each chemotherapy appointment 
Trazodone 200mg PO 2h prior each chemotherapy appointment 
ACP 25mg PO - reduce to 1/2 tablet  2h prior each chemotherapy appointment 

Comments:  We are pleased with Neo's quality of life and progress.  Overall his cancer and renal parameters remain stable and we will continue with the current protocol.  We will see Neo again in 6-8 weeks time.  Please feel free to call or email if you have any further queries regarding Neo.

Diagnosis: Urothelial carcinoma; surgically resected Aug 2025 (incomplete margins, lymphatic invasion and high MC); adjuvant NSAIDs/ chemotherapy.  Staging; no overt metastases. Mitoxantrone # 2 doses then progressive disease; change to vinblastine #5 doses; currently on chlorambucil tablets.  

History: Overall chlorambucil is going well; he is stable at home.  There has been no deterioration.  Last time he took a long time to recover from the sedation (2 days!), slow breathing.  He is still a bit fussy with eating, changed to Lyka and he is eating normally.  He is drinking as usual.  Urination - intermittently some blood and starts well but then slower.  Very consistent but no accidents in the house.  Energy may be a bit lower; more difficult to do the longer walks; used to 7-8km; and now doing about half of this.  
- Jumping up on the bed/ couch OK but more reluctant to jump; some discomfort.  

Physical Examination findings: Bright, alert and responsive.
Oral: unable to assess, requires muzzle
Heart & Lungs: no murmurs or arrhythmia noted on auscultated, normal respiratory rate and effort, normal bronchovesicular sounds bilaterally 
Abdomen: soft and comfortable abdomen on palpation, 
Rectal exam: normal intestinal lining, no internal lymphadenopathy, soft stools on glove
Integument: no lesions, urine or ectoparasites noted
Mm pink, crt - not checked (muzzled), HR 160, RR pant, Temp 39.1, Wt: 25.4kg

Laboratory results: Standard profile:
Haematology: WCC 4.6 (LLN 5.3); neutrophils normal; no other concerns
Biochemistry: 
Creat 262 (was 247); ULN 117
Urea 23.8 (was 25); ULN 9.2; 
No other concerns; renal levels stable.   

Treatment: 
-Continue Chorambucil: Give 2 tablets once daily from Mon to Sat with no tablets on Sundays  (have 25 left)
-Ondansentron 8mg as required - another 1 box
- Turkey tail 
- CBD oil (Vet prescription)
- Gabapentin 300mg 2 hours prior to each visit and up to twice daily as required for pain/ discomfort.  

Comments: We are pleased Neo remains clinically stable. We will await his repeat blood panel to assess his renal parameters and will see Neo again in 4-6 weeks time.  Please feel free to call or email if you have any further queries regarding Neo.