Pre chemo Consults (Dogs)

NEW CONSULTATION PRE-CHEMOTHERAPY FOR DOGS - 2023-10-15 by Dr. Emily Carter. Presentation: Max, a 7-year-old Golden Retriever, was referred by Dr. John Smith for evaluation prior to chemotherapy for lymphoma. Pre-referral diagnosis: Lymph node biopsy confirmed lymphoma. Chest X-ray showed no metastasis. Paraneoplastic pathology screening was negative. Owner relevant history: Max has been lethargic and has had decreased appetite for 2 weeks. He responded partially to prednisone. Currently, he is stable but lethargic. Previous history: Owned for 5 years. Neutered. Up-to-date on vaccinations and preventative care. No travel history. Normal appetite and diet until recently. Normal water intake, urination, and defecation. No vomiting or diarrhea. Occasional coughing. No known allergies. No seizures. Normal exercise tolerance. Fasting for 12 hours. Previously on prednisone. Additional tests: Urinalysis normal. Urine culture negative. Hematology showed mild anemia. Biochemistry normal. Presenting medications: Prednisone, 20 mg, once daily, oral, last administered 2023-10-14. Physical examination: Body weight: 30 kg, BCS: 5/9. Coat condition: dull. Musculoskeletal: normal. Demeanor: calm. Gait: normal. Eyes: clear. Ears: clean. Nose: moist. Oral cavity: mild tartar. Integument: no lesions. Peripheral lymph nodes: enlarged. Cardiovascular assessment: Mucous membranes: pink. Heart rate: 100 bpm, regular rhythm. No heart murmur. Femoral pulses strong. Respiratory rate: 20 breaths/min, normal effort. Upper airway: clear. Lung sounds: normal. Abdominal assessment: Abdominal palpation: no masses. Urogenital examination: normal. Rectal examination: normal. Prostate palpation: normal. Rectal temperature: 38.5°C. Practicalities of chemotherapy: Owner interested in chemotherapy. Protocol: CHOP regimen. Discussed general and specific drug complications. Advised against raw feeding. Owner concerned about side effects. Practical concerns include frequent visits. Fasting status: 12 hours. Important information: Patient anxiety level: low. Raw food diet: not applicable. Pre-chemotherapy organ dysfunction: Gastrointestinal: no vomiting or diarrhea history. Renal: Baseline creatinine: 1.2 mg/dL, normal. Cardiac: Normal auscultation. Hepatic: Baseline ALT: 45 U/L, normal. Baseline bilirubin: 0.3 mg/dL, normal. Hematology: Baseline PCV: 35%, mild anemia. Baseline platelet count: 200,000/µL, normal. Baseline neutrophil count: 5,000/µL, normal. Diagnostic Tests: Blood gas: normal. CT thorax: no metastasis. CT abdomen: no abnormalities. Prostate wash cytology: normal. Problem list: 1. Lymphoma 2. Mild anemia 3. Decreased appetite Plan: 1. Initiate CHOP chemotherapy protocol. 2. Monitor CBC weekly. 3. Re-evaluate in 2 weeks.