C10027691 / invoice 10000

Reason: Revisit RUNNING 10 LATEHistory:About a week ago Sirius had some very loose diarrhoea with a reasonable amount of blood present.  He has been a bit quiet since then, and has been lame on his right hind leg.He was seen at the local clinic and had a in-house blood profile which showed some mild changes including a mild thrombocyopenia (100), but unknown if smear evaluated.  He was commenced on prokolin, omeprazole, metrobactin, gabapentin and paracetamol, and recommended to reduce the toceranib to 65mg EOD.The diarrhoea has stopped and the faeces are looking normal.  He is eating normally, but remains quieter than usual.  He has only had two doses of gabapentin.  He has some lameness in his right back leg.Examination:Sirius is quite bright and alert here.  He has an altered right hind gait with a swinging motion and reduced weight bearing.  The anal sac mass is similar to previously described as are the pelvic lymph nodes.  Caudal abdominal nodes are palpable on abdominal palpation.There was no obvious pain around the hip or pelvic area.The abdominal palpation was comfortable.Thoracic auscultation was unremarkable.Laboratory:In-house urine dipstick - 3+ protein, trace blood.  Sample submiited to UoM for urinalysis and UPC.  Assessment:It is not clear if the diarrhoea and blood were secondary to the toceranib.  The platelet count is not low enough for spontaneous bleeding.  There was no other obvious cause.  I discussed with the owner that when a dog on toceranib has diarrhoea we usually suggest stopping the medication and see if it resolves, which will happen in 24-48 hours in most cases.  We can then rechallenge.  If an ongoing problem, then we will try a MWF protocol rather than reducing each dose.  A dose of 65mg is 2.1mg/kg, lower than the recommended lowest dose fo 2.25mg/kg.  It is not clear if the mild lethargy is secondary to the toceranib (not common, but seen), the gabapentin (only had 2 doses), or possibly the anal sac carcinoma.  The lameness could be due to nerve compression and/or pain, so using the gabapentin is recommended.Plan:Owners to continue medications as dispensed.To give 80mg toceranib on Sunday (when next due) to assess tolerance.We will call on Monday to discuss the urine results and how Sirius is going.    Vital Signs    MMColour: pink;       Weight: 31;       HeartRate: 132;       BodyScore: 5/9;       RespirationRate: 24;       CRT: < 2;