C10030607 / invoice 10000

Weight (Kg):6.9
History:History: Mumu presented for a recheck of his stomatitis after 4 weeks of treatment with molnupiravir, doxycycline, and meloxicam. O reports he is comfortable at home and compliant with medications mixed in food. No V+/D+ or other side effects noted. Appetite is good, resulting in a 400g weight gain.

Physical Examination:
- BAR
- Weight: 6.9 kg - overweight
- Eyes & ears clear, free from discharge or inflammation.
- Oral Exam: Significant improvement in oral inflammation compared to previous visit. Mild inflammation persists, particularly in the caudal mouth, 109 & 209 still in situ and have not been extractewd. Moderate gingival recession noted around the incisors especially 204. Canines appear diseased - query super-eruption especially on maxillary arcades. Strongly suspect periodontitis/FORLs rather than stomatitis affecting the gingiva in this location
- MM pink & moist, CRT <2, no skin tent.
- Cardiothoracic auscultation clear with no murmurs/arrythmias, crackles or wheezes. Pulses strong & synchronous.
- Abdominal palpation soft & comfortable with no palpable masses, organomegaly or thickenings.
- No peripheral lymphadenopathy
- Skin & coat in good condition

Diagnostics:
- Photos of oral cavity taken for monitoring. Sent to info email to be attached to file

Treatment:
- Molnupiravir dose increased to 1/2 of a 200mg capsule (100mg) daily due to weight gain - just slightly less than 15mg/kg

Recommendations & Follow Up/Discussion:
- Discontinue doxycycline and meloxicam. Continue molnupiravir for 8 weeks.
- Monitor for signs of oral discomfort (drooling, pawing at mouth, inappetence) over the next week as anti-inflammatory is withdrawn. O to send photos in 1 week.
- Monitor for any adverse effects (e.g., vomiting) from the increased molnupiravir dose.
- Nurse appointment in 4 weeks for a weight check. O advised to bring P in sooner if home scales indicate weight has dropped below 6.7kg (or 6.9kg in their robot cat litter box as is currently measuring Mumu at 7.1kg so 200g discrepancy relative to our scales), as a dose adjustment may be required.
- Discussed long-term management and the potential need for future extractions of remaining teeth due to periodontal disease.
- Recheck consultation in 8 weeks to assess response to therapy and consider weaning off anti-viral

LG