3/5/2019

DVM Intake Exam Estimated age: Estimated 1-2 years based on dentition and overall appearance Microchip noted on Intake? Scanned neg on LVT intake - MC placed at that time History : Stray. Finder is familiar with the cats in the area and this cat was new, and appeared to be injured. Ate half of wet food this morning. Subjective: At back of kennel, alert Observed Behavior - Comes to the front when I open the door, lurches around the kennel and seems relaxed with handling Evidence of Cruelty seen - None Evidence of Trauma seen - Wounds to hind legs Objective QAR, BCS 2/9, pink MMs EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Mild tartar, tips of both max canine teeth are fractured PLN: No enlargements noted H/L: NSR, NMA, Lungs clear, eupnic, no coughing or sneezing ABD: Soft, non painful, no masses palpated, not distended U/G: Female, no mammary masses or vulvar discharge MSI: Wobbly on RHL, and possibly LHL as well. Swelling in middle of RHL. Skin free of parasites, no masses noted, healthy hair coat. CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Normal externally Sedated with Dexdomitor 0.07 ml IM and butorphanol 0.04 ml IM for blood draw and rads of hind legs. The RHL has a large slightly purple mass in the calf region (caudal to the tibia), approx 20 cm x 8 cm x 4 cm, and a partial-thickness linear wound extending along the caudal aspect of the leg in this region, with mild bloody discharge. The mass was aspirated - only blood was aspirated. There are also two scabs on the RHL - one on the ventral hock and one to the side of this, both with mild purulent discharge and swelling. The LHL has a scab on the ventral hock, with mild purulent discharge and swelling. Sedation was partially reversed with Dexdomitor 0.03 ml IM. Assessment 1. Wounds to RHL and LHL 2. Mass RHL - R/O hematoma vs. infection secondary to wound at the caudal aspect of this mass 3. Emaciation 4. Mild tartar and fractured teeth Prognosis: Fair Plan: 1. Simbadol 0.2 ml SQ SID x7 days 2. Convenia 0.15 ml SQ once today; repeat in 7 days SURGERY: Temporary waiver due to wounds and emaciation 1088

3/5/2019

CBC: Hct 17.8% WBC 42 k/ul - severe neutrophilia and monocytosis Plt 216 k/ul Chemistry: Glucose 153 mg/dl BUN 32 mg/dl, creat 0.7 mg/dl Mild hypernatremia Albumin 2.7 g/dl Liver values unremarkable ASSESSMENT: 1. Anemia - R/O infectious vs. anemia of chronic inflammation vs. blood loss (GI parasites vs. wounds) 2. Severe leukocytosis - R/O infection 1088

3/6/2019

S/0 - Pt QAR but lethargic - prolonged skin tent - Reported to eating today R - 20 T - 101 P - 180 Prolonged skin tent MMB pale pink tachy EENT - no ocular or nasal discharge - blepharospasm OU Ambdomen - soft non painful CNS - dull mentation MSK - hind limbs wounds healing - wounds dry with no purulent discharge noted - mild soft tissue inflammation BW history - marked non regenerative anemia (17.8) with marked leukocytosis (41.9) with neutrophilia (36) and monocytotsis (1.87) A 1. Eating and drinking - dull/lethargic mentation 2. Dehydration 3-5% 3. Wound healing 4. Moderate anemia - working diagnosis: blood loss secondary to parasitism vs hemolysis vs other (decreased RBC's production) 5. Marked leukocytosis - infectious secondary to wounds vs inflammation vs other systemic infectious causes 6. Underweight P Continue Supportive Care - Vit B 12 0.3 ml - SQ fluids SID 100 ml for 3 days - Apply Advantage Multi 1 tube once only - Medical feedings - Doxycycline 10 mg/kg SID po for 14 days

3/7/2019

S/O - pt QARH - eating tuna and drinking - attention seeking - still appears fearful/lethargic HR 200 R wnl T - np MMB pink tachy H/L - nsr; no arrythmias - clear eupnic Abdomen Soft - palpable feces MSKI - Ambulatory x 4 A - pt stable, eating and drinking, hydration normal - Fearful in kennel - quiet - doesnt move around alot in the kennel - Mucus membranes pink P - Cont on current plan - Schedule for repeat BW 3/9/2019 to ck for progress

3/8/2019

SO Cat with severe non-regenerative anemia and PL wounds, bilaterally. P is BAR in kennel and eating well. EN -- eyes and nose are clear. no discharge. H/L -- no murmur auscultated. lung sounds are clear. MM are pale pink, conjunctiva appears pale pink. A severe non regenerative anemia -- r/o infectious, inflammatory, blood loss leukocytosis -- r/o infectious, inflammatory wounds to L PL P continue on current tx plan CBC to be repeated on 3/9

3/10/2019

H/O MARKED ANEMIA AND LEUKOCYTOSIS QAR EENT- DDZ; PALE PLN- WNL HL-200HR REG NM ABD- RELAXED UG- FS MSI- BC 3/9 NEURO- NSF A) R/O ANEMIA OF CHRONIC DISEASE VS POOR NUTRITION VS NEOPLASIA VS BLOOD LOSS VS BLOOD DESTRUCTION VS OTHER P) REPEAT PCV AND CBC 3/11

3/11/2019

EATING WELL BAR PINK EENT- NEG ORAL PLN- WNL HL- 200HR REG NM FS FP ABD- RELAXED UG- FI MSI BC 4/9 A) ANEMIA BUT IMPROVING; LEUKOCYTOSIS BUT IMPROVING P) CBC- MATURE LEUKOCYTOSIS; ANEMIA PCV- 20% CONTINUE WITH SUPPORTIVE RX

3/12/2019

Hx: Anemia, emaciation, wounds to LHL and RHL and mass in middle of RHL. Bloodwork on 3/5 showed Hct 17.8%; 3/9 showed Hct 15.7%, 3/11 showed 19.4%. RBC regeneration seen on 3/9 and 3/11. WBC count is trending towards normal. S: Dull in kennel - curled up at back of kennel, reluctant to get up. Slightly tense for exam. O: -Wounds are all scabbed over, with no swelling, discharge or erythema -Mass on medial RHL is smaller and more discrete than previously - firm, with discrete margins. Pt yowls when I press on it. It is near the popliteal LN but this LN can be palpated separately. A: 1. Anemia - regenerative, but persistent - R/O blood loss vs. RBC parasites vs. other 2. Mass on RHL - R/O hematoma vs. developing abscess vs. tumor vs. other 3. Persistent dullness - R/O pain vs. anemia vs. other P: 1. FNA mass on RHL, continue monitoring Hct 1088

3/14/2019

Q-BAR H PINK PALE EENT- LIMITED ORAL EXAM (NERVOUS) PLN- WNL HL- 200HR REG ABD- RELAXED MSI- THIN; SMALL GROWTH ON R HL A) H/O ANEMIA (UNKNOWN ORIGIN) THIN SMALL GROWTH ON R HL EATING WELL

3/14/2019

HX: ANEMIA; POOR BODY CONDITION; MASS EFFECT ON RIGHT MEDIAL ASPECT PROXIMAL TO STIFLE AREA BAR H PINK PALE EENT- DIFFICULT TO ASSESS TEETH PLN- WNL HL- 200HR REG NM SS FP C AND E MSI- SOFT NODULAR MASS EFFECT MEDIAL ASPECT NEAR STIFLE AREA (2 CM X 2 CM X 1/2 CM) NEURO- NSF A) ANEMIA OF CHRONIC DISEASE NODULAR EFFECT- R/O NEOPLASIA VS LIPOMA VS OTHER P) EXCISIONAL VS INCISIONAL BX

3/15/2019

CBC only as per rounds DVM. Results stored in vet documents. DVM advised.

3/15/2019

History - Came into MACC on the 5th March; emaciated wounds on the right and left hind as well as a soft tissue mass caudal to the right radius - Hct 17.8%; WBC 42 k/ul - severe neutrophilia and monocytosis - BW performed 4 X since arriving at MACC - HCT slowly increasing to 23 % today and WBC slowly decreasing to 35.91 today S/O - pt eating and drinking - attention seeking - no skin tent - mmb pink + wet HR - 192 R - WNL T - 97.9 EENT - nasal congestion with dry mucoid nasal discharge; eye clears; ears clear MSKI - ambulatory x 4 - RH + LH wounds mostly healed - bruising remains on the medial aspect of leg - soft tissue mass remains 1 inch in diameter caudal to the left radius - non painful non ulcerative CNS normal mentation CBC/CHEM Moderate anemia (no regeneration) - 23%; Moderate leukocytosis (29.63); moderate neutrophilia (25); mild monocytotis (1.86); mild basophilia (0.28) A 1. Pt stable; eating and drinking; hydration normal 2. URI - mild to moderate 3. Blood work: Anemia improving, WBC's resolving 4. Wounds on hind-end healing 5. Round soft tissue mass on hind right 1 inch in diameter - rule out: hematoma/abscess/benign neoplasia vs reactive lymph node vs other 6. Mild decrease in temp 7. Other (poor BCS; fractured canines) Plan - Do not perform further blood work - CBC/CHEM performed 4 X since arriving in MACC - monitor and request referring vet to repeat BW as needed - Continue supportive care - Warm towels and place in kennel - Place in East Holding until placement New Hope - Patient will need follow up internal medicine consultation to monitor current progress including FNA/Biopsy of soft tissue mass on right hind if no regression

3/17/2019

SO recheck overall status; hx of severe regenerative anemia. QAR, sleeping curled up in back of kennel. Reluctant to get up and stand on her own. Picked up for PE, P gently tries to go back to her bed. There is moderate amount of urine in litter box EN -- Audible congestion, epiphora and sneezing. Skin -- slightly prolonged skin tent A anemia of unknown origin dental disease emaciation mass wound dehydration (~3%) lethargic? P LRS SQ fluids 100ml q24h x 3 days nebulization q24h x 4 days little remedies 1 drop per nostril q12h x 3 days

3/18/2019

SO recheck overall status. hx of severe regenerative anemia; last bloodwork shows improvement (HCT 23%, originally 17%) . QAR, sleeping in her bed. Easily roused for exam but will gently try to go back to bed. EN -- Audible congestion, epiphora and sneezing. Skin -- slightly prolonged skin tent A anemia of unknown origin dental disease emaciation mass wound dehydration (~3%) lethargy P continue on current tx plan. continue monitoring daily in shelter.

3/20/2019

SO History of improving anemia, emaciation, wounds, soft tissue mass, lethargy and recently diagnosed with a URI Today pt is lethargic, mildly prolonged skin tent and scant dried mucoid discharge - Dry food bowl empty Prolonged skin tent EENT - scant dry mucoid nasal discharge, mild nasal congestion - no ocular discharge, eyes clean Abdomin - soft non painful Ambulatory x 4 CNS - normal mentation A - History of Anemia (other - emaciation; wounds; soft tissue mass hind right stifle medial aspect) Currently 1. URI Moderate 2. Lethargy 3. Poor BCS 4. Prolonged skin tent - dehydration vs elasticity of skin P - Extend Doxycycline 10 mg/kg for 5 days - Extend sq fluids 100 ml SID for 3 days - Place on TID Feedings with A/D NEW HOPE - PATIENT WILL NEED SEEK FOLLOW UP A Veterinary CONSULTATION for underlying conditions including an internal medicine consultation and repeat Blood work