7/14/2018

DVM Intake Exam Estimated age: Approximately 9-12 years Microchip noted on Intake? Negative scan History : Stray Subjective: QAR, gentle, allows all handling, eats voraciously when offered canned food Evidence of Cruelty seen - neglect Evidence of Trauma seen - none Objective P = wnl R = wnl BCS = 2/9 EENT: Eyes - marked ptosis OU with periocular erythema/swelling, mucoid discharge with cloudy corneas OU, nuc sclerosis OU. Ears heavy thick grey/brown discharge/debris AU, pinnae edges rough/crusted AU. No nasal discharge noted Oral Exam: Moderate to severe tartar, gingivitis, gingival recession PLN: No enlargements noted H/L: NSR, grade III/VI heart murmur, SSP, Lungs clear, eupnic ABD: Tense, but non painful, no masses palpated U/G: Intact male with two scrotal testicles, one smaller than the other MSI: Ambulatory x 4, but severe pelvic limb ataxia and weakness, significantly delayed CPs, withdrawal and deep pain present, no spinal pain, bilaterally thickened stifles, unable to fully extend hips, crepitus in hips bilaterally, severe generalized muscle atrophy and emaciation, decreased skin turgor, several dermal nodules (sebaceous adenoma/skin tag), diffuse/generalized epidermal crusting with easily epilated fur and yeasty smell, CNS: Mentation appropriate Rectal: Externally normal Assessment: Pelvic limb ataxia/weakness - ro OA +/- emaciation/muscle atrophy vs Degenerative myelopathy vs IVDD vs neoplasia vs other neurologic dz Emaciation/muscle atrophy - ro neglect vs neoplasia vs other Dehydration Heart murmur Marked ptosis/conjunctivitis Epidermal crusts/easily epilated fur Prognosis: Guarded pending diagnostics and response to care/treatment Plan: CBC/Chem/T4 SQF LRS 600ml Ears/eyes cleaned. Ears appear healthy once debris/dirt cleaned. Eye fluorescein stain - very faint generalized corneal uptake (no obvious focal ulceration) Intake treatments Continue to monitor while at BACC (appetite, mobility) In future, recommend cardio workup, dental cleaning. Pending response to adequate diet and care, likely will need longterm management/rehabilitation for pelvic limb weakness and OA SURGERY: Permanent waiver due to heart murmur

7/14/2018

Mild nonregenerative anemia (HCT 29.2) - ro chronic disease vs neoplasia vs malnutrition/emaciation vs other Mild neutrophilia - ro inflammation (infection vs neoplasia vs other chronic dz) Mild hyperglobulinemia - ro inflammation vs infection vs dehydration vs neoplasia

7/15/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness CBC/Chem/T4 performed Mild nonregenerative anemia (HCT 29.2) ,Mild neutrophilia , Mild hyperglobulinemia Given SQF, started on neopolybac. S: QAR to BARH. No csvd. Eating well. Urinating large amounts. Allowed all handling. CRT: <2s. Gums: pink, moist Eyes: Ptosis OU with mild to moderate peri-ocular erythema/scabbing and mild mucoid discharge OU. Ears: Mild to moderate erythema with mild ceruminous discharge Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: Grade II heart murmur ausculted . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 with moderate hindlimb weakness/ataxia/stilted gait. No back pain elicited. Needs help rising, but then can walk with minimal support. moderate hindlimb muscle wasting. BCS = 3/9 Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- suspect hip OA but cannot r/o other orthopedic conditions such as ruptured CrCL or OA elsewhere. Cannot completely r/o neurologic cause such as IVDD, neoplasia vs less likely infectious/inflammatory meningitis 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o allergic vs infectious vs immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded Plan: Continue Neopolybac OU BID Start Carprofen 2.2mg/kg PO BID x 7 days Start gabapentin 10 mg/kg PO BID x 7 days Start Simplicef 10 mg/kg PO SID x 7 days

7/16/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness CBC/Chem/T4 performed Mild nonregenerative anemia (HCT 29.2) ,Mild neutrophilia , Mild hyperglobulinemia Given SQF, started on neopolybac. S: QAR to BARH. No csvd. Eating well. Urinating large amounts. Allowed all handling. CRT: <2s. Gums: pink, moist Eyes: Ptosis OU with mild to moderate peri-ocular erythema/scabbing and moderate to severe mucoid discharge OU. Ears: Mild to moderate erythema with mild ceruminous discharge Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: Grade I heart murmur ausculted . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Needs help rising, but can walk with minimal support. moderate hindlimb muscle wasting. BCS = 3/9 Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. STT OS <5, OD 0 Assessment 1) Hindlimg ataxia/weakness- suspect hip OA but cannot r/o other orthopedic conditions such as ruptured CrCL or OA elsewhere. Cannot completely r/o neurologic cause such as IVDD, neoplasia vs less likely infectious/inflammatory meningitis 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Start Optimmune OU BID x 7days Continue Carprofen 2.2mg/kg PO BID x 7 days Continue gabapentin 10 mg/kg PO BID x 7 days Continue Simplicef 10 mg/kg PO SID x 7 days Seek NH placement for palliative care

7/17/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness CBC/Chem/T4 performed Mild nonregenerative anemia (HCT 29.2) ,Mild neutrophilia , Mild hyperglobulinemia Given SQF, started on neopolybac. 7/16 STT OS <5, OD 0 S: QAR to BARH. No csvd. Eating well. Urinating large amounts. Friendly, Allowed all handling. CRT: <2s. Gums: pink, moist Eyes: Ptosis OU with mild to moderate peri-ocular erythema/scabbing and mild mucoid ocular discharge OD, moderate OS Ears: Mild to moderate erythema with mild ceruminous discharge Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: No murmur ausculted today . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Needs help rising, but can walk with minimal support. moderate hindlimb muscle wasting. BCS = 3/9 Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- suspect hip OA but cannot r/o other orthopedic conditions such as ruptured CrCL or OA elsewhere. Cannot completely r/o neurologic cause such as IVDD, neoplasia vs less likely infectious/inflammatory meningitis 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Continue Optimmune OU BID Continue Carprofen 2.2mg/kg PO BID until 7/22 Continue gabapentin 10 mg/kg PO BID until 7/22 Continue Simplicef 10 mg/kg PO SID until 7/22 Seek NH placement for palliative care

7/18/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness, poor body condition. On 7/16 noted minimal tear production.7/18 doing well in cage- walks with assistence and dribbles urine when walking but holds bladder while in cage; defecated in cage; eating well BCS- 3/9 S: QAR to BARH. No csvd. CRT: <2s. Gums: pink, moist Eyes: ectropion with moderate conjunctivitis OU and mild mucoid discharge Ears: crusty pinna tips, clean canal Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: No murmur ausculted today . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Needs help rising; can walk with support; moderate hindlimb muscle wasting. Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- Hip OA v. CrCL tear v. neurologic v. other 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur historical- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Continue Optimmune OU BID Continue Carprofen 2.2mg/kg PO BID until 7/22 Continue gabapentin 10 mg/kg PO BID until 7/22 Continue Simplicef 10 mg/kg PO SID until 7/22 Seek NH placement for palliative care

7/19/2018

Progress exam/ health certificate H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness, poor body condition. On 7/16 noted minimal tear production.7/18 doing well in cage- walks with assistence and dribbles urine when walking but holds bladder while in cage; defecated in cage; eating well BCS- 3/9 S: QAR to BARH. No csvd. CRT: <2s. Gums: pink, moist Eyes: ectropion with moderate conjunctivitis OU and mild mucoid discharge Ears: crusty pinna tips, clean canal Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: No murmur ausculted today . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Needs help rising; can walk with minimal support; moderate hindlimb muscle wasting. Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- Hip OA v. CrCL tear v. neurologic v. other 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur historical- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Continue Optimmune OU BID Continue Carprofen 2.2mg/kg PO BID until 7/22 Continue gabapentin 10 mg/kg PO BID until 7/22 Continue Simplicef 10 mg/kg PO SID until 7/22 Seek NH placement for palliative care

7/20/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness CBC/Chem/T4 performed Mild nonregenerative anemia (HCT 29.2) ,Mild neutrophilia , Mild hyperglobulinemia Given SQF, started on neopolybac. 7/16 STT OS <5, OD 0 S: QAR to BARH. No csvd. Eating well. Urinating large amounts. Friendly, Allowed all handling. CRT: <2s. Gums: pink, moist Eyes: Ptosis OU with mild to moderate peri-ocular erythema/scabbing and mild mucoid ocular discharge OD, moderate OS Ears: Mild to moderate erythema with mild ceruminous discharge Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: No murmur ausculted today . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Needs help rising, but can walk with minimal support. moderate hindlimb muscle wasting. BCS = 3/9 Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- suspect hip OA but cannot r/o other orthopedic conditions such as ruptured CrCL or OA elsewhere. Cannot completely r/o neurologic cause such as IVDD, neoplasia vs less likely infectious/inflammatory meningitis 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Continue Optimmune OU BID Continue Carprofen 2.2mg/kg PO BID until 7/22 Continue gabapentin 10 mg/kg PO BID until 7/22 Continue Simplicef 10 mg/kg PO SID until 7/22 Seek NH placement for palliative care

7/21/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness CBC/Chem/T4 performed Mild nonregenerative anemia (HCT 29.2) ,Mild neutrophilia , Mild hyperglobulinemia Given SQF, started on neopolybac. 7/16 STT OS <5, OD 0 Added Optimmune S: QAR to BARH. No csvd. Eating well. Urinating large amounts. Friendly, Allowed all handling. CRT: <2s. Gums: pink, moist Eyes: Ptosis OU with mild to moderate peri-ocular erythema/scabbing, no discharge noted today Ears: Mild to moderate erythema with mild ceruminous discharge Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: No murmur ausculted today . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Needs help rising, but can walk with minimal support. moderate hindlimb muscle wasting. BCS = 3/9 Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- suspect hip OA but cannot r/o other orthopedic conditions such as ruptured CrCL or OA elsewhere. Cannot completely r/o neurologic cause such as IVDD, neoplasia vs less likely infectious/inflammatory meningitis 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Continue Optimmune OU BID Continue Carprofen 2.2mg/kg PO BID until 7/22 Continue gabapentin 10 mg/kg PO BID until 7/22 Continue Simplicef 10 mg/kg PO SID until 7/22 Seek NH placement for palliative care

7/22/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness CBC/Chem/T4 performed Mild nonregenerative anemia (HCT 29.2) ,Mild neutrophilia , Mild hyperglobulinemia Given SQF, started on neopolybac. 7/16 STT OS <5, OD 0 Added Optimmune S: QAR to BARH. No csvd. Eating well. Urinating large amounts. Friendly, Allowed all handling. CRT: <2s. Gums: pink, moist Eyes: Ptosis OU with mild peri-ocular erythema/scabbing Ears: Mild to moderate erythema with mild ceruminous discharge Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: No murmur ausculted today . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Needs help rising, but can walk with minimal support (not for very long). moderate hindlimb muscle wasting. BCS = 3/9 Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- suspect hip OA but cannot r/o other orthopedic conditions such as ruptured CrCL or OA elsewhere. Cannot completely r/o neurologic cause such as IVDD, neoplasia vs less likely infectious/inflammatory meningitis 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Continue Optimmune OU BID Extend Carprofen 2.2mg/kg PO BID until 7/29 Extend gabapentin 10 mg/kg PO BID until 7/29 ok to d/c simplicef

7/23/2018

H: Intake on 7/14. Noted to have heart murmur, hindlimb ataxia/weakness CBC/Chem/T4 performed Mild nonregenerative anemia (HCT 29.2) ,Mild neutrophilia , Mild hyperglobulinemia Given SQF, started on neopolybac. 7/16 STT OS <5, OD 0 Added Optimmune S: QAR to BARH. No csvd. Eating well. Urinating large amounts. Friendly, Allowed all handling. CRT: <2s. Gums: pink, moist Eyes: Ptosis OU with mild peri-ocular erythema/scabbing Ears: Mild to moderate erythema with mild ceruminous discharge Nasal Cavity: No nasal discharge. Oral Cavity: moderate dental tartar PLN: WNL Heart: No murmur ausculted today . Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. U/G: Intact male with two descended testicles (one bigger than the other). No discharge. Musculoskeletal: Ambulatory x 4 though weaker on the left side. Able to get up on own today and walk, but not very long. moderate hindlimb muscle wasting. BCS = 4/9 Integument: roughened haircoat; diffuse epidermal crusting/scabbing, seborrhea Neuro: Appropriate mentation. Moderate hindlimb ataxia/weakness. CP WNL x4. Rectal: Not performed. Externally normal. Assessment 1) Hindlimg ataxia/weakness- suspect hip OA but cannot r/o other orthopedic conditions such as ruptured CrCL or OA elsewhere. Cannot completely r/o neurologic cause such as IVDD, neoplasia vs less likely infectious/inflammatory meningitis 2) Emaciation/muscle atrophy - r/o neglect/malnutrition vs underlying systemic disease (ie neoplasia) 3) Heart murmur- r/o underlying heart disease (MVD, DCM) vs physiologic (DRVOTO) 4) Marked ptosis/conjunctivitis- r/o suspect immune-mediated (kcs) 5) Dermatitis- r/o allergies (atopy, food) vs parasitic (demodex, sarcoptes) vs immune-mediated vs neoplasia Prognosis: Guarded to poor Plan: Continue Neopolybac OU BID Continue Optimmune OU BID Continue Carprofen 2.2mg/kg PO BID until 7/29 Continue gabapentin 10 mg/kg PO BID until 7/29 leaving today

7/24/2018

left before exam could be performed

Bear during intake appeared mellow but also appeared in pain.He was unable to stand up. But counselor was able to collar, scan and photograph him. He hard difficulty walking into the cage bank. He allowed to be picked up.