C10027229 / invoice 10000

13/03/2026 Diagnosis::Intermediate to large B cell lymphoma (flow cytometry). 5 months post last chemotherapy treatment; 9 months post diagnosis; Restart CHOP (relapsed) week 9 Doxorubicin

History: 
Overall Pepper is well although there is a noticeable decrease in energy. she is still active and has bursts of energy.  Her appetite remains normal. She has gained weight despite no change in food intake. Paul suspects that it has to do with her decreased energy level. There is no Vomiting or diarrhoea other than slightly soft stool this morning. 


Physical Examination findings: Bright, alert and responsive.
Oral; mild periodontal disease
Heart Lungs: no murmur or arrhythmia, tachycardic, most likely due to stress; normal respiratory effort and bronchovesicular sound bilaterally 
Abdomen: slightly tense on palpation but not painful
Rectal: unremarkable
Lymph node: no lymphadenopathy
Integ: no lesions, wounds and ectoparasites noted
Mm pink, crt < 2 secs, HR 132, RR panting, Temp 39.5, Wt: 9.2

Laboratory results: CBC performed in house with manual blood film assessment.
Hct: 0.5
WCC: 15.63
Neuts: 13.31
Platelets:194

Manual differential count:  Neutrophils 93%, Lymphocytes 1%, Monocytes 6%, Eosinophils 0%.
Platelets: clumped and adequate
Morphology: Normal 

Treatment: 9.2mg doxorubicin (1mg/kg) was administered IV via a 22g catheter in the right cephalic vein using the closed injection Equashield system.
1mg/kg maropitant administered IV immediately prior to chemotherapy
Reduce prednisolone to 5mg PO twice a week for one week and discontinue.

Comments: It was a pleasure to see Pepper today
We will see Pepper again in 2 weeks' time.  Please feel free to call or email if you have any further queries regarding Pepper.