C10028314 / invoice 10000

Reason: RecheckIntern: SC History: Bailey, 15y 1m. MN, Ragdoll being managed for his small cell low grade alimentary lymphoma, diagnosed 1/11/24. Chlorambucil/prednisolone commenced 10/12/24 (delayed due to acute abdominal hernia 3 weeks post op). He developed circling April'25 and noted forebrain disease on examination. Chemotherapy stopped 20/1/26 due to difficulty medicating. 1/11/24: Exploratory laparotomy - full thickness biopsies of stomach, jejunum and ileum for 6 months history of weight loss. Histopathology was consistent with small cell alimentary lymphoma. QML lab reference: 24-58476075MACROSCOPIC1. Stomach biopsy: The specimen consists of a single piece of tissue  measuring 8 x 4 x 6 mm. Bisected 1A.2. Jejunum/small intestinal biopsy: The specimen consists of a single  piece of tissue measuring 11 x 6 x 4 mm. Quadrisected 2A.3. Ileum/small intestinal biopsy: The specimen consists of a single  piece of tissue measuring 6 x 5 x 4 mm. Bisected 3A.MICROSCOPIC: see attached report for extensive microscopic evaluationDiagnosis:Stomach: Within normal limitsIntestinal small cell, low grade lymphomaADDENDUM 22.11.24:CD3: Over 95% of the cells of interest are strongly positive. These features confirm a T-cell phenotype.5/11/24: Bailey was presented to ECC department at ARH for ongoing management. PCV/TP at presentation was 13/58 with multiple transfusion triggers (tachycardia, weak femoral pulse, paresis and hyperlactemia (4.6)). Feline whole blood transfusion was given on 5/11. Doxycycline was commenced while mycoplasma PCR was pending. Due to severe acute drop in Hct without accompanying TP, hemolysis was favoured instead of hemorrhage. 6/11/24: Abdominal ultrasound did not detect intra abdominal hemorrhage. There was mild ileus of small intestine with some fluid and food content. Thoracic radiograph was unremarkable. Cobalamin asssay 690 pmol/L (Ref 214-1107). 7/11/24: PCV/TP static (25/70) and Bailey was discharged from hospital. QML anemia panelMycoplasma haemofelis DNA Not DetectedMycoplasma haemominutum DNA Not DetectedMycoplasma turicensis DNA Not DetectedBartonella spp. DNA Not DetectedAnaplasma platys DNA Not Detected11/11/24: PCV/TP 24/68. Bailey was presented to oncology department at ARH for discussion of management of his small cell LSA. Shaya has elected to commence chlorambucil/prednisolone but decided to withold for a week as she was travelling for work. 21/11/24 : PCV/TP: 31/76 (clear). Prednisolone commenced at 5mg PO SID. Chlorambucil 2mg to be commenced pending bloodwork. 21/11/24: Presented to ARH ECC 11pm for acute onset swelling of the abdomen. PEx noted four finger spaced abdominal herniation with herniated intestine in SQ space. PCV/TP: 26/70 (clear serum). Surgical repair of abdominal hernia performed overnight by ARH Sx team. Eating well post operatively. Transitioned from methadone to buprenorphine due to profound dysphoria and sedation. Bailey was discharged home the following morning. Bailey developed seroma about day 7 post op (confirmed via focal ultrasound). 26/12/24: Bailey was presented to ECC for acute circling and bumping into things. He was hospitalised overnight with view of transferring his care to oncology team the following morning. Neurological assessment noted peripheral vestibular disease, suspected otitis media. Amoxyclav course was commenced and circling resolved a week following antibiotic course.  18/3/25: Shaya has presented Bailey for an urgent appointment as she is concerned that he was hypothermic (36.6 rectal temp, no feces in rectum) and pale mucous membrane. He was restless for the past few days and he has stopped grooming. Bailey has been eating well otherwise. Bailey's neurological examination was largely normal, revealing no overt signs of persistent vestibular disease. Bailey's movement seems overall restricted, with hesitancy to walk and inconsistent discomfort responses on musculoskeletal examination. Pregabalin dose was increased, with view of adding CBD oil if required. 23/3/25: Bailey presented to ECC due to acute bruising of the left inner groin. He was kept overnight for monitoring and discharge the next morning. Chlorambucil was withhold for a week.2/4/25: Restaging clear. He has been gaining and maintaining weight since commencing chlorambucil/pred and the addition of oncology care diet. Bailey presented to ECC for acute circling episode. Neuro assessment with CTN/PR on 16/4 noted forebrain disease (ddx: vascular vs neoplasia). Shaya has declined MRI advanced imaging. However, Shaya is happy to continue treatment for his small cell lymphoma and continued with monthly visit.16/7/25: Bailey had developed more frequent circling episode. He was weaned off prednisolone 2 weeks prior to the episode and this has not helped with his inappropriate urination episode. His appetite has also decreased since discontinuing prednisolone. Neuro assessment has not detected significant worsening since previous examination 3 months ago. Prednisolone reinstated. Phone report 11/7/25 noted worsening of circling episodes where the family noticed tight circling. He continue to eat, drinking and toilet well otherwise. Prednisolone was increased to 5mg PO SID. Shaya does not think the increased prednisolone dose change the circling behaviour. She has noticed another episode over the weekend where it was difficult to break the circling episode. The addition of CBD oil has helped with the circling episode and increased dose of prednisolone also helped maintain appetite and weight gain. 17/12/25: The family elected to stop chlorambucil due to difficulty medicating. We discussed options of pulse dosing (could be administered by oncology nurses with administration fee). 18/2/26: The owner is comfortable with her decision to stop chemotherapy altogether and at this stage prioritising on keeping Bailey comfortable. At thirst stage Bailey was EDDU but has episodes where he stared blankly in space. Today ### Physical Exam: Weight - 5.3kg -  prev 5.5kgBCS  4/9, cachectic and sarcopenic - subjective improvement in fat deposits and overall coverage  BAR, growling throughout exam as per usualHR  bpmRR  min MMs: Pink, CRT 1s Ocular: NADAural: Otoscopic examination not performed; L pinna generalised hairloss, otherwise external examination unremarkable. Nasal: NADOral: subjectively head shy and started growling when performing oral exam; full oral exam not performed/mouth not opened; mild dental disease ; no petechia/ecchymoses noted Cardiovascular: no murmur audible, heart rhythm regular. Femoral pulses strong and synchronous. Respiratory: Lung sounds clear in all 4 quadrants with no evidence of any crackles or wheezes. No evidence of any abnormal areas of increased resonance or dullness. Abdomen: slightly tense, but otherwise unremarkableLNs: all peripheral nodes palpably within normal limitIntegument: good skin coat overall Urogenital: NADNeurological: -static; no circling behaviour noted today MSK: ambulating well in cat ward, no significant proprioceptive deficits noted in both pelvic limbs, slightly hunched posture at lower back, slightly exaggerated gait on the left pelvic limb; not circling today. No evidence of trauma to hind-limb paws. Moderate muscle wastage; improved fat coverage with mild improvement in overall body condition. Coat unkempt; subjectively static. Rectal: not performed Assessment: Small cell alimentary lymphoma (full thickness biopsies of jejunum and ileum on 1/11; stomach wnl)- thorax clear 6/11/24, restaging clear 2/4/25- commenced prednisolone 20/11/24, stopped due to abdominal evisceration and reinstate 9/12/24- currently in remission Dec'25 (1 year post diagnosis)- maintained on chlorambucil and prednisolone - stopped chlorambucil 20/1/26 due to difficulty medicating Pertinent:** Acute circling April'25- CTN 16/4/25- forebrain disease - Inappropriate urination, urine culture negative 2/4/25- worsening of neurological sign (2/7) --> prednisolone dosing increased to 0.82ml (5mg/ml liquid) - Previously detected anemia post ex lap start of Nov'24- unclear exact aetiology, Mycoplasma negative; PCV on the day of surgery unknown, it is possible that the initial Hct of 40 was inaccurate and subsequent anemia secondary to increased RBC fragility - 27/12: acute onset of peripheral vestibular disease, suspect secondary to otitis media; responsive to antibiotics (amoxyclav)- Neuro assessment on 18/3 did not detect neurological deficits, suspected OA- Acute abdominal evisceration 21/11/24, surgically repaired Laboratory: Nil in house today Treatment: Prednisolone 4.5mg PO SID (~1mg/kg) at 0.9ml PO SID predmix liquidContinuePregabalin 25mg/ml compounded solution- 0.25ml to 0.5ml PO BID CBD oil (10mg/ml)-  0.2ml PO BIDMaropitant 8mg PO SID PRNClient Communication:Plan:Recheck ~ 2-4 weeks (MBA due Feb'25, ideally repeat USG same time) ; full blood test q 3mo** Elected to forego ongoing restaging and MRI investigation; *** DO NOT dispense ondansetron - Shaya develops severe anaphylactic reaction (owner has Cerenia tablet at home) **    Vital Signs    Weight: 5.3;       MMColour: P;       Temperature: CNG;       HeartRate: 160;       CRT: CNG;