1/18/2023

DVM Intake Exam Estimated age: 12y Microchip noted on Intake? scanned positive History: Reported owner had passed away, but brought in by friend of relative of deceased. Subjective: BAR Observed Behavior - Allows all handling, but remained tense. Evidence of Cruelty seen -no Evidence of Trauma seen -no Objective T = P =wnl R =wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: moderate dental tartar, linear gingivitis PLN: No enlargements noted H/L: NR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, suspect cranial abdominal mass U/G: female intact, small linear scar caudal abdomen c/w OHE MSI: Ambulatory x 4, skin free of parasites, no masses noted, unkempt hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: normal external Wood's Lamp Exam: not performed Assessment underweight suspect cranial abdominal mass Prognosis: guarded Plan: intake tasks cbc/chem/T4 to lab house in medical to monitor for decline during hold if doing well and gaining weight consider placement for hospice, consider EHR if not thriving SURGERY: already spayed

1/19/2023

Hx: Senior cat being monitored after suspected abdominal mass palpated on intake exam. Blood sent to lab/ S: BAR, eating wet food with very good appetite O: eent: mms pink and moist, eyes clear, no ocular or nasal dc apparent h/l: heart ok no murmur detected, lungs clear abd: abd palp soft and non painful, large amount of feces, cranial abd mass not appreciated lns: all pln wnl int: healthy hair coat, no external parasites noted ms: ambulatory x4 neuro: mentation alert and appropriate A: underweight P: mass not appreciated today, but has large amount of feces. Possible suspected mass was feces. Will monitor for feces production and palpate again tomorrow cbc/chem/T4 CBC WBC 55.2 (3.9-19.0 K/ul) neutrophilia monocytosis noted to have smudge cells present in blood smear Chem BUN 39 (16-37) all electrolytes slightly higher than normal range TP 4.8 (6.3-8.8) ALB 2.1 (2.6-3.9) Glob 2.7 (3-5.9) ALT 25 (27-158) marked hypoproteinemia r/o decreased intake v malabsorption v other still possible there is neoplasia, but could also be IBD or similar starting 0.25ml vitamin B12 1000mcg/ml sc weekly for 4 weeks if doing well, but not gaining weight will plan to start conservative steroid course.

1/20/2023

Hx: Senior cat with suspected abdominal mass S: BAR, seeking attention and allows all handling with soft body. Eating wet food with very good appetite O: eent: mms pink and moist, eyes clear, no ocular or nasal dc apparent h/l: heart ok no murmur detected, lungs clear abd: abd palp soft and non painful, again able to palpate approximately 3cm abd mass possibly adhered to small intestines lns: all pln wnl int: healthy hair coat, no external parasites noted ms: ambulatory x4 neuro: mentation alert and appropriate A: abd mass-r/o mesenteric LN v other underweight P: continue weekly B12 sc x4w plan in house abd us if time allows

1/21/2023

Abdominal palpation: An approx 3 cm firm mass palpable caudoventral to kidneys. Thickened loops of intestines feel adhered to mass. Abdominal ultrasound: Images attached Rounded mass of mixed echogencity visible mid abdomen. No intestinal loops seen entering or exiting mass r/o enlarged lymph +/- adhered mesentary A segment of intestinal wall is asymmetrically thickened with loss of layering in mid abdomen r/o mural mass (adenocarcinoma vs mast cell tumor vs lymphoma) A: Neutrophilia Hypoproteinemia Abdominal mass Asymmetric focal thickening of intestine Prognosis: Poor. Neoplasia is of primary concern given focal nature of abnormality on palpation and ultrasound. IBD may also be present. Pet is comfortable and eating now but concern for obstruction and metastasis in next couple of months. Plan Consider sedation for aspiration of mass (the presumed lymph node) and chest radiographs. Cytology may not give definitive diagnosis however. Alternatives: Internal medicine consult for ultrasound and cytology of intestinal mass, surgical biopsy or hospice care.

1/21/2023

Hx: Senior cat with confirmed abdominal, highly suspicious for neoplasia S: BAR, seeking attention and allows all handling with soft body. Eating wet food with very good appetite O: eent: mms pink and moist, eyes clear, no ocular or nasal dc apparent h/l: heart ok no murmur detected, lungs clear abd: abd palp soft and non painful, approx 3cm abd mass possibly adhered to small intestines palpable in cranial abdomen lns: all pln wnl int: healthy hair coat, no external parasites noted ms: ambulatory x4 neuro: mentation alert and appropriate A: abd mass-r/o neoplasia v other P: recommend placement for hospice care or further work up if placed for hospice care recommend to dispense prednisolone to start for palliative treatment

1/22/2023

S. Suspected abdominal mass. BAR, very friendly, eating great, urinating normally, FS2, no v/d/c/s reported O: BAR, pink/moist mm, skin tent slightly prolonged EENT: clear OU, no ocular discharge, clean AU,normal pinna, NND H/L: no murmur or arrhythmias, pulse S+S, lungs clear, eupneic Abd: minimal palpation, mass noted appreciated today on palpation lns: all pln wnl int: healthy hair coat, no external parasites noted ms: ambulatory x4 neuro: A+A A: abd mass-r/o neoplasia v other P: recommend placement for hospice care or further work up

1/23/2023

S. Suspected abdominal mass. BAR, very friendly, purring. AS 2/3, urinating normally, FS2, no v/d/c/s reported. O: BARH, pink/moist mm, skin tent slightly prolonged EENT: clear OU, no ocular discharge. Clean AU, no erythema noted. No nasal discharge noted. H/L: No murmur or arrhythmias ausculted, pulse S+S. Lungs clear bilaterally, eupneic Abd: Approx 3cm multilobulated, firm mass palpated mid abdomen. Otherwise no organomegaly, fluid wave noted. Soft and comfortable on palpation. lns: all pln wnl int: Small firm dermal mass on right aspect of nasal bridge. Healthy hair coat, no external parasites noted ms: Ambulatory x4. Moderate generalized muscle wasting. BCS 3/9 neuro: Mentally alert and appropriate. A: Abd mass -r/o neoplasia (carcinoma vs lymphoma) vs lymphadenopathy vs other P: Recommend placement for hospice care vs further work up (cytology/IM consult/CXR) vs HE if declines Consider dispensing prednisone if interested in palliative treatment. Continue B12 injections weekly for 4 weeks. -DLG

1/24/2023

S. Suspected abdominal mass. BAR, very friendly, purring. AS 2/3, drank most of water bowl overnight. Urinating normally, no feces overnight, no v/d/c/s reported. O: BARH, pink/moist mm, skin tent slightly prolonged EENT: clear OU, no ocular discharge. Clean AU, no erythema noted. No nasal discharge noted. H/L: No murmur or arrhythmias ausculted, pulse S+S. Lungs clear bilaterally, eupneic Abd: Approx 3cm multilobulated, firm mass palpated mid abdomen. Otherwise no organomegaly, no fluid wave noted. Soft and comfortable on palpation. lns: all pln wnl int: Small firm dermal mass on right aspect of nasal bridge. Healthy hair coat, no external parasites noted ms: Ambulatory x4. Moderate generalized muscle wasting. BCS 3/9 neuro: Mentally alert and appropriate. A: Abd mass -r/o neoplasia (carcinoma vs lymphoma) vs lymphadenopathy vs other P: Recommend placement for hospice care vs further work up (cytology/IM consult/CXR) vs HE if declines Consider dispensing prednisone if interested in palliative treatment. Continue B12 injections weekly for 4 weeks. -DLG

1/25/2023

S. Suspected abdominal mass. BAR, very friendly, purring. Great appetite - AS 1, drank all of water bowl overnight. Urinating normally. No v/d/c/s reported. Weight = 5lb6oz today O: BARH, pink/moist mm, CRT <2s skin tent prolonged EENT: clear OU, no ocular discharge. Clean AU, no erythema noted. No nasal discharge noted. H/L: No murmur or arrhythmias ausculted, pulse S+S. Lungs clear bilaterally, eupneic Abd: Approx 3cm multilobulated, firm mass palpated mid abdomen. Otherwise no organomegaly, no fluid wave noted. Soft and comfortable on palpation. lns: all pln wnl int: Small firm dermal mass on right aspect of nasal bridge. Healthy hair coat, no external parasites noted ms: Ambulatory x4. Moderate generalized muscle wasting. BCS 3/9 neuro: Mentally alert and appropriate. A: Abd mass -r/o neoplasia (carcinoma vs lymphoma) vs lymphadenopathy vs other Skin tenting likely associated with body condition and age, not hydration status P: Recommend placement for hospice care vs further work up (cytology/IM consult/CXR) vs HE if declines Consider dispensing prednisone if interested in palliative treatment. Continue B12 injections weekly for 4 weeks. -DLG

1/26/2023

Suspected abdominal mass. BAR, very friendly, purring. Eating all food overnight, drank all of water bowl overnight. Urinating normally. No v/d/c/s reported. O: Updates from last exam: BARH, No ocular or nasal discharge noted. Abdominal mass still present. Mentally appropriate A: Abd mass -r/o neoplasia (carcinoma vs lymphoma) vs lymphadenopathy vs other Mild weight loss P: Recommend placement for hospice care vs further work up (cytology/IM consult/CXR) vs HE if declines Unless transferring to rescue in next couple of days, start prednisone treatment for palliative care. Continue B12 injections weekly for 4 weeks. -DLG