Last week a Tanzi was put through xrays , ultrasounds and aspirated of lymphs and spleen. The good news is that Tanzi is officially in clinical remission. Everything that was there back on Jan 9th is gone i.e. from lymphs , spleen, liver and lungs. Everything but one 6 cm x 6 cm mass. The diagnosis is that its  a hyperplastic nodule i.e. a benign growth. However, the doctors wanted the spleen removed. After much agony we decided not to. The operation would have meant setting back Tanzi a month on his chemo and we felt that would kills his odds to beat the lymphoma. It is also a major operation which can be risky and has its seto of pretty dire complications. To us its a game changer. Tanzi’s odds of beating cancer were on the line but frankly we felt that his general quality of life would have gone down hill from there. On the other hand any growth on the spleen can burst leading to internal bleeding which requires immediate surgery. We’ll take the chance. We are lucky that we currently can watch him 24×7 since my wife works from home.

Tanzi has been feeling well all week, so far the doxyrubicin has not floored him at all except for diarrhea which started on Friday. As a matter of fact , although he has been having watery diarrhea  we still managed to do a 3 hour on Sunday. He is still quite hungry even though we stopped the preds this past thursday. Tanzi had developed a twitch and at nite would almost incessantly it seems lick both of his front legs. All that has stopped and we are guessing that the preds  were just making him very anxious. As to the diarrhea we decided to not go back on the Flagyl which somehow seems to make him very lethargic. So far it seems that the antibiotics cut down on his energy level much more than the actual chemo. Instead we are going with increasing his dosage of l-glutamine as well as using Thorne Research’s Gastroplex product. We actually bought a lot of Thorne Research at www.wellvet.com. Hopefully, these will manage to contain his diarrhea. The other good news is that he is still no longer showing any signs of blood in either his stool or penis discharge.

Today is another big day. Tanzi is going through a set of tests in order to “re-stage” him i.e. in order to understand if he is in remission and whether he can proceed with two sessions of radiation. Let’s hope.

- NYC Veterinary Specialists - Queens -

107-28 71st Road • Forest Hills, New York 11375 • (718) 263-0099 Main (718) 263-0098 Fax

Medical Record

for

“Tanzi”

Patient Information:

Tanzi (#18415)

Rhodesian Ridgeback

Tan

Male

7 year

______________________________________________________________________

February 03, 2009

TPR (9:09 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

Temperature = 101.6

Pulse= 180

Respiratory Rate= 30

Weight: 41.000 kg, 90.20 lb, 1.19 m2

LABORATORY (9:10 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

PRESENTING COMPLAINT (10:13 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

02-03-09: Chemo

HISTORY (10:13 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

Here for chemotherapy.

Had a couple of days of tolerable vomiting and diarrhea. Resolved now.

No bloody discharge from penis/prepuce in many days.

PHYSICAL EXAMINATION (10:14 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

BAR. H Pk 1s

EENT: No ocular or nasal discharge. Mucous membranes pink and moist, crt <2s. Mild dental calculus. Clean ears.

PLN: all wnl,NP axillaries, inguinals, & popliteals

HL: No murmurs or arryhthmias, strong synchronous pulses, normal BV sounds.

ABD: soft non-painful

UG: Intact male, testes smooth and symmetrical.

MSI: BCS = 4.5/9, well muscled.

DIAGNOSIS (10:17 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

LSA, high grade, stage IVa: PLNs, spleen, liver, +/- lungs–CR(?)

CHOP chemotherapy started 1/8/9

Suspect prostatitis–resolved

Diarrhea–resolved

DIAGNOSTICS (10:17 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

CBC in-house

Pre-Adria echo done last week

TREATMENT (10:18 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

ADRIA #1–35.8 MG IV IN SALINE INFUSION

BENADRYL–35.8 MG IV

DISCHARGE INSTRUCTIONS (10:23 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

Everything went fine today.

Tanzi is due in 1 week for re-evaluation to determine his remission status. In order to accomplish this, he will need the following tests (see attached financial estimate): physical examination, routine CBC, lymph node aspirate and cytology test, chest radiographs and abdominal ultrasound. If, on the abdominal ultrasound, anything abnormal or suspicious is seen in the spleen or liver, a fine needle aspirate of that may also be necessary.

If Tanzi is determined to be in remission next week, then on Thursday, he will need to be dropped-off in Manhattan for his radiation therapy simulation. The first radiation treatment would be given on Tuesday of the following week.

WRITTEN COMMUNICATION (10:23 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

DISCHARGE ORDERS for “Tanzi”

February 03, 2009

SEEN BY: Timothy A Rocha DVM DACVIM Oncology

REFERRING VETERINARIAN: Dr. Teresa Paoloni

REFERRING CLINIC: Veterinary Care Unlimited

OWNER: Charles Monteiro

PHONE:

PATIENT: “Tanzi”, Rhodesian Ridgeback, Male, 7 years

Discharge Instructions:

Everything went fine today.

Tanzi is due in 1 week for re-evaluation to determine his remission status. In order to accomplish this, he will need the following tests (see attached financial estimate): physical examination, routine CBC, lymph node aspirate and cytology test, chest radiographs and abdominal ultrasound. If, on the abdominal ultrasound, anything abnormal or suspicious is seen in the spleen or liver, a fine needle aspirate of that may also be necessary.

If Tanzi is determined to be in remission next week, then on Thursday, he will need to be dropped-off in Manhattan for his radiation therapy simulation. The first radiation treatment would be given on Tuesday of the following week.

Diagnostics:

CBC in-house

Pre-Adria echo done last week

Treatment:

ADRIA #1–35.8 MG IV IN SALINE INFUSION

BENADRYL–35.8 MG IV

Diagnosis:

LSA, high grade, stage IVa: PLNs, spleen, liver, +/- lungs–CR(?)

CHOP chemotherapy started 1/8/9

Suspect prostatitis–resolved

Diarrhea–resolved

Please don’t hesitate to call if you have any questions or concerns regarding Tanzi’s progress at home. Also, keep in mind that our hospital is open 24 hours a day, in the event of an emergency.

________________________________________

Timothy A Rocha DVM Karen Oberthaler VMD

DACVIM Oncology DACVIM Oncology

WRITTEN COMMUNICATION (10:24 am QUE Tim Rocha, DVM DACVIM (Oncology)/que)

February 03, 2009

Dr. Teresa Paoloni

Veterinary Care Unlimited

84-09 Rockaway Blvd.

Ozone Park, NY 11416

Fax: (718) 296-1266

Dear Dr. Paoloni:

Thank you for referring Charles Monteiro and his dog Tanzi. I am always glad to participate in the medical care of your patients.

Reason for Visit 02-03-09: Chemo

Diagnosis:

LSA, high grade, stage IVa: PLNs, spleen, liver, +/- lungs–CR(?)

CHOP chemotherapy started 1/8/9

Suspect prostatitis–resolved

Diarrhea–resolved

Diagnostics:

CBC in-house

Pre-Adria echo done last week

Treatment:

ADRIA #1–35.8 MG IV IN SALINE INFUSION

BENADRYL–35.8 MG IV

Discharge Instructions: Everything went fine today.

Tanzi is due in 1 week for re-evaluation to determine his remission status. In order to accomplish this, he will need the following tests (see attached financial estimate): physical examination, routine CBC, lymph node aspirate and cytology test, chest radiographs and abdominal ultrasound. If, on the abdominal ultrasound, anything abnormal or suspicious is seen in the spleen or liver, a fine needle aspirate of that may also be necessary.

If Tanzi is determined to be in remission next week, then on Thursday, he will need to be dropped-off in Manhattan for his radiation therapy simulation. The first radiation treatment would be given on Tuesday of the following week.

Thanks again for allowing me this opportunity to meet Tanzi and Charles Monteiro. If you have any more questions regarding Tanzi’s case or any others, please feel free to call.

Sincerely,

_____________________________________________

Timothy A Rocha DVM

DACVIM Oncology

Over all a good week.

Strong walks a few over 2 hours .

On Saturday Tanzi threw up twice . Once after a car ride and then later that evening. He also started having diarreah again.Woke us up 3 times to go outside and do #2.

The blood in his stool and discharge are gone.

He has a definite strong appetite but after throwing up on Saturday he got a bit picky. We will consider putting him on Flagyl again if the diarreah does not subside soon or if we see blood in the stool again.

We introduced Bovine Collostrum as a daily supplement at least until the diarreah is controlled. Also Q10 was increased to 360mg as we approach next week when Tanzi is given doxyrubicin.

Again most of the week was quite good up to Saturday. The drug given this week was Vincristine. The previous week was not as great. The drug then was Cytoxan and he was also under Flagyl and Clavamox.

So far nothing really horrible but we are freaking out over the doxyrubicin being introduced tomorrow.