8/1/2026

DVM Intake Exam Estimated age: 4-6 years based on dentition, consistent with owner reports Microchip noted on Intake? Scanned positive History: Owner passed away. Reported to have a history of attacking tail which led to tail amputation. Cat has reportedly been attacking tail again. Subjective: QAR Observed Behavior - tense + frozen for tasks and exam Is there evidence of suspected cruelty? No Objective: T = P = WNL R = WNL BCS: 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Adult dentition, very mild tartar PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: Externally WNL, spayed female, green tattoo noted MSI: Ambulatory x 4, no ectoparasites noted, no masses noted, healthy hair coat. Wound with fleshy pink granulation tissue at tail tip. CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally WNL Wood's Lamp Exam: not performed Assessment: Wound to tail tip (photos in vet docs) Spayed female Prognosis: Good Plan: Intake tasks + exam Radiographs: soft tissue lesion at tip of tail vertebrae CBC/CHM in house Flushed tail wound with LRS Applied soft bandage with tefla pad to tail wound to keep clean Zorbium for appropriate weight Gabapentin 100mg capsule PO BID x14d Recommend leaving shelter for quiet environment May need second tail amputation vs. starting on SSRI for self trauma SURGERY: Already spayed

8/1/2026

CBC HCT 44% Hgb 13.0 g/dL WBC 11.4 K/uL - mild neutrophilia 10.9 K/uL - lymphopenia 0.25 K/uL CHM Glucose 149 mg/dL SDMA 10 ug/dL Creatinine 0.9 mg/dL BUN 19 mg/dL Lytes WNL Hyperglobulinemia 5.6 g/dL (2.8-5.1) ALT/ALP WNL A: Stress leukogram Elevated globulins- r/o inflammatory vs. other P: CWCT Prioritize leaving shelter

8/3/2026

S: Recheck tail trauma, appetite. Currently on Gabapentin, zorbium. Appetite is still 1/3, poorly. O: Tail wrapped and no attempt to mess with it. A: Appetite is poorly even with stress and pain management. P: Add mirtazapine x 3d and see if that jump starts the appetite.

8/5/2026

S/O: BAR, eating MSI: Removed bandage, tail tip macerated, approx. 4cm long A: Recurrent tail mutilation Osteolysis on radiographs of distal vertebrae Prognosis: Fair P: Tail amputation, schedule with offsite surgeon Simbadol 0.6ml SQ once a day for 2 days +/- ecollar

8/12/2026

Pre-Op Exam S/O: BAR, no c/s/v/d noted EENT: No ocular or nasal discharge noted Lungs: Eupneic, normal respiratory rate/effort ABD: No obvious distention MSI: Ambulatory x 4, no notable lameness CNS: Mentation appropriate A: Appears to be suitable candidate for anesthesia, ASA status I P: Accepted for surgery - spay/neuter today Tail Amputation- V- incision, disarticulated proximal to affected vertebrae, closed SQ with 3-0 Monocryl, closed skin with 3-0 Monocryl in a simple interrupted pattern. No Suture removal. Zorbium post-op Clavamox 62.5 mg PO BID -> 8/21

8/14/2026

[Panleukopenia/Parvovirus exposure - LOW RISK] Exposure date: 8/14/2026 Notes: Vaccinated prior to exposure/shedding date or previously altered/microchipped with suspected previous vaccine history. Considered low risk. No quarantine required.

8/16/2026

[Post Surgical Exam] Attitude/demeanor: BAR Appetite: eating well C/S/V/D: none Incision site: no swelling, bruising, or bleeding; sutures appear intact Pain level: appears comfortable Licking, chewing, or biting surgical site noted: no Additional notes: n/a

8/17/2026

Alerted by staff e-collar not on and appears to be chewing at tail amp site Sedated with 0.1mL dex/torb IM - light but adequate sedation Tail amp site dehiscence with scabbing, foreign debris and scant serosanguineous dc, moderate swelling . No boney changes on rads A. Post op complication post tail amp P. Scheduled for sedated repair, concerned that is too much tissue needs to be debrided might need tail amp reduced by additional vertebrae if possible. Simbadol 0.24mg/kg SQ once (0.6mL) e-collar placed recheck comfort tomorrow

8/18/2026

Recheck day 6 post-op tail amputation - noted to have been chewing/biting at tail amp site, e-collar placed last night (not previously in place post-op) S/O: QAR, leans into pets, no c/s/v/d noted; e-collar in place EENT: No ocular or nasal discharge ORAL: mm pink and moist, CRT <2; some missing teeth, moderate to heavy tartar, some gingival recession; stage 3-4 ddz LUNGS: Eupneic MSI: Tail amp site has thick crusts and debris/hair, two puncture wounds at ventrodistal tail, no active discharge from sx site or wounds CNS: Appropriate mentation Anesthetized per sx protocol -Soaked tail in warm water with dilute chlorhex, used gauze to gently remove debris and crusts to better evaluate wound, several sutures came off -Wound edges are jagged and skin no longer apposed -White connective tissue appreciated along length of incision with no full thickness dehiscence appreciated -Tissue along sx site is erythematous and swollen -Two, adjacent puncture wounds ~2mm at ventral aspect of distal tail (proximal to sx site) appreciated -After soaking and cleaning, flushed copiously with sterile saline -Dried and placed non-stick pad with soft padded bandage -**Images of sx site and wounds uploaded to vet docs A: Tail amputation (second) - 6 days post op History of tail amputation prior to intake at shelter, reportedly due to self mutilation Self mutilation of tail - ro pain vs feline hyperesthesia vs other Dental disease P: Start onsior 2 mg/kg SQ SID Zorbium applied topically Increase gabapentin to 30 mg/kg PO BID Keep e-collar on at all times, scheduled daily checks Recheck and rebandage in 2-3 days CTM closely while at QACC

8/19/2026

Brief recheck - QAR, good appetite, e-collar in place, tail bandage in place. Continue with current treatment plan and recheck/rebandage tomorrow.

8/20/2026

recheck tail amp site, performed 8/12 offsite -noted to be self mutilating 8/17 -sedated cleaning done on 8/18 and bandaged S/O T: 100.9 QAR, noted to appear lethargic and allowed for full tail cleaning and removal of non-stable sutures and bandage with minimal reaction. Staff unsure if eating, not taking HVTs aTT EENT: no ocular or nasal dc HL: eupneic MSI: fibrous tissue and mucopurulent dc noted under the bandaged area, suture dehiscence, Left side appears to have healthier looking granulation tissue than the left, fibrin and mucopurulent dc on the L side of center, neither edge opposed CNS: mentation appropriate but quiet In house BW: very mild anemia (29.3)- r/o preregen, non-regen sl L creat (0.7) H globulins (6.1) r/o inflam A. Tail amp post op complications Lethargy weight loss (9.26 pounds today) P. Unclear if p is eating aTT- given convenia 8mg/kg SQ once (0.43mL) removed bandage and sutures that weren't intact, soaked with dilute chlorohex and thoroughly flushed with saline. e-collar on, left site open to see if allows for better healing, p given paper litter Monitor log for appetite priority recheck tomorrow seek placement asap- strongly suspect p will need high tail amp and closer monitoring than can be provided in shelter post op to ensure no self mutilation CTM closely at QACC

8/21/2026

Recheck - noted to be very lethargic yesterday, allowed handling of tail wound and bandage removal without sedation or protest S/O: QAR, frozen/hunched but allows all handling, reported to have eaten well overnight, large amount of urine in LB this AM; no c/s/v/d noted. *Early afternoon recheck - at front of kennel eating (both dry and wet trays nearly empty), but quickly retreats to the back of the kennel when I approach EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4, healthy haircoat; tail amp dehiscence appears appears mostly dry and stable with minimal cloudy/pink exudate at left side of sx site (photos uploaded to vet docs) CNS: Appropriate mentation A: Tail amputation dehiscence secondary to self mutilation - appears stable today Quiet mentation vs lethargy - ro secondary to increased dose of gabapentin + opiod vs other Weight loss in care Dental disease History of two tail amputations (one prior to admission to shelter, one on 8/12 in shelter) P: Continue gabapentin and e-collar to prevent pain/access to tail CTM closely while at QACC **Tail should eventually heal by second intention. This would be ideal if Sabby is comfortable and not attempting to go after her tail. Removal of her e-collar should only happen once the wound is completely healed and with supervision to ensure she does not self mutilate. If the tail is not healing, another tail amputation may be warranted, but this will be close to the tail base and comes with a higher risk. If there is an underlying cause for Sabby to continuously attack her tail, other medications (ie. anxiolytics) and/or behavior modification plans should be pursued.

8/26/2026

Recheck post-op tail amp with complications (dehiscence due to licking/chewing) S/O: QAR, timid but allows handling, good appetite, no c/s/v/d noted; e-collar in place EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Tail amp site stable with scab/crust covering, some debris/fur caught up in scab, no discharge or significant swelling appreciated CNS: Appropriate mentation A: Tail amputation x 2 due to self trauma - ro secondary to pain vs neurologic vs other Dental disease Weight loss in care P: Continue gabapentin at 30 mg/kg PO BID Recheck tail in one week, CTM on rounds

9/2/2026

Recheck tail amp site- surgery 3 weeks ago (8/12), noted to have licked/chewed at surgery site 5 days later (8/17) S/O: QAR, timid and hides at back of kennel, at front of kennel during one check and she quickly retreats to the back when the door is opened; e-collar in place, allows all handling, did not eat overnight and not eating today; no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4; tail amp site has thick dry crust obscuring distal area, no significant swelling or erythema appreciated CNS: Appropriate mentation A: Tail amputation complication (self trauma) - scab vs eschar covering Hx of multiple tail amputations due to self trauma - ro neuro vs other Dental disease Weight loss in care P: Monitor appetite closely - previously eating well Continue gabapentin and e-collar CTM closely on rounds If scab/eschar does not fall off in the next week or so, consider soaking and examining more thoroughly

9/3/2026

DVM Progress Notes for Inappetence -Inappetence persistent. -No change on PE to yesterday's note. -Gave 0.04 ml of Midazolam (0.05 mg/kg of 5 mg/ml) IV once at ~5 pm. -P then readily ate all wet food available. -Recheck tomorrow for appetite. -Recheck as scheduled on 9/8 for tail amputation + E-collar. -Maintain on ARL pending tail amputation recheck; consider Medical Deadline if not consistently eating.

9/4/2026

Brief recheck Resting comfortably in kennel no c/s/v/d reported fair appetite for wet and dry food reported OK to recheck tail amp site as scheduled, notify DVM if anorexia recurs

9/6/2026

Brief recheck QARH - Resting comfortably in kennel pink moist mm no c/s/v/d reported 1/7 stool reported this AM -- firm but depressible stool in descending colon, no straining to defecate noted, comfortable on abdominal palp fair appetite for wet and dry food reported Tail amp site appears healing well r/o early constipation ADD Lactulose 2mL PO BID x7d Recheck on 9/8 as scheduled

9/8/2026

DVM Progress Exam S/O: -QAR; intermittent hyporexia/anorexia continues. -No defecation noted since 9/6. -Tail amputation site appears to be healing well with minimal scabbing/crusts and minimal redness/swelling remaining; E-collar remains in place. A: -Tail amputation complication/self-mutilation - currently stable, healing well -Hx multiple tail amputations secondary to self-trauma -Intermittent hyporexia/anorexia -Constipation - no defecation since 9/6 -Dental disease -Weight loss in care P: -ADD medical feeding SID x 5 days. -Continue Lactulose as prescribed. -Recheck appetite/defecation in 1-2 days. -Recheck tail in 5 days. If tail remains appropriately healed, remove E-collar and monitor VERY closely for recurrence of self-mutilation. E-collar removal should occur only when adequate supervision is available for the first several hours; if adequate supervision is not available, bump task no more than 1-2 days. -Remove from ARL at this time due to acceptable clinical stability. -If self-mutilation recurs, place Medical Deadline or return to ARL with recommendation for maximum 5 lists, then proceed to QA. -May consider maximally one additional tail amputation in-house if clinically indicated. -CTM closely while at QACC.

9/9/2026

DVM Progress Exam, Brief -Today, P is E/D and defecated - no longer constipated. -Continue with plan per prior assessments. -CTM through routine Medical shelter operations practices.

9/15/2026

Brief exam S: BARH - friendly pink moist mm no c/s/v/d reported d/u/d/e WNL O: Tail incision mostly healed with pinpoint scab at center A/P: Suspect feline hyperesthesia syndrome Removed P ecollar - checked on P ~q1hr throughout day to ensure P not self-mutilating tail Recc replace ecollar when P unsupervised overnight Only have fluoxetine CAPSULES in shelter, not appropriate dose for P -- discussing ordering fluoxetine tablets vs compounded oral suspension with supervisors

9/16/2026

Recheck tail amputation site. History recap: -Surrendering owner reported that she was biting her tail and had to have it amputated, then continued biting it post-op. -Surrendered to us and due to tail wounds, needed a second tail amputation. No e-collar placed post-op and she again bit her tail and opened it up. -Now, the surgery site has healed by second intention with an e-collar in place for the past 5 weeks. -Considering starting fluoxetine for suspected feline hyperesthesia syndrome, but appropriate doseage form not in stock S/O: BAR, good appetite, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4, tail tip healed with pin point scabbing CNS: Appropriate mentation A: History of biting tail, resulting in two tail amputations - ro feline hyperesthesia syndrome vs an inciting injury to tail that has caused this sequence of amputations and resultant pain/biting P: Removed e-collar this AM Leaving tail alone throughout the day Replace e-collar overnight Continue gabapentin at 30 mg/kg PO BID *Since Sabby seems to be leaving tail alone at this time and also because we don't have appropriate dosage form of fluoxetine in stock (and furthermore, it takes weeks to take effect once started), consider continued close monitoring with e-collar off during the day and returned overnight. If continues to leave tail alone, may not need long-term medication

9/17/2026

Brief DVM Progress Note -E-collar was not in place at AM check. -Kept E-collar off through entire day; will keep E-collar off indefinitely. -Multiple cage-side assessments today - no directly observed or evidence of self-mutilation. -Tail twitching and dorsal rippling observed multiple times. -Tail self-mutilation recheck tomorrow.

9/18/2026

Daily tail check - BAR, active, tail stable with tiny healing scabs; no self trauma. CTM closely on rounds; consider starting fluoxetine when we have it in stock.

9/20/2026

BAR, A+A, tail stable, no signs of self trauma. CTM and start fluox when available

9/21/2026

BAR, A+A, tail stable, no signs of self trauma. CTM and start fluox when available

9/22/2026

Recheck tail, noted URI signs S/O: BAR, leans into petting, allows all handling; good appetite, no c/s/v/dnoted EENT: Mild mucoid nasal discharge, no ocular discharge ORAL: mm pink and moist, CRT <2; tartar, gingival recession, gingivitis most notable at 108/208 with some missing teeth LUNGS: Mild congestion, otherwise eupneic MSI: Amb x 4, tail tip healthy/healed CNS: Appropriate mentation A: URI Dental disease Hx self trauma to tail - ro feline hyperesthesia syndrome vs injury or other inciting cause for self trauma P: Move to med iso Start fortflora PO SID x 10 days CTM closely on rounds Consider fluoxetine if able to get in stock Recommend dental with placement

9/23/2026

DVM Progress Exam S/O: -QAR; tail tip remains healthy/healed with no evidence of recurrent self-mutilation. -Currently receiving gabapentin 30 mg/kg PO BID. -Currently undergoing treatment/monitoring for CIRDC. -Hx recurrent tail self-mutilation resulting in two tail amputations A: -Hx recurrent tail self-mutilation; currently stable without recurrence. -Suspected feline hyperesthesia syndrome vs other underlying behavioral/neurologic/pain-associated etiology. -CIRDC. P: -Continue Gabapentin 30 mg/kg PO BID. -Once clinically recovered from CIRDC, start Fluoxetine 2 mg (1/4 of Reconcile 8 mg chews) PO SID and maintain long-term. Veterinarian ACR placed for 10/2. -Recommend maintaining both gabapentin and fluoxetine for a minimum of 2 weeks after fluoxetine initiation before considering gradual weaning/discontinuation of gabapentin. -Recommend continuing fluoxetine through transition/placement and for a minimum of 1-2 months after placement to allow for decompression/adjustment before considering gradual weaning under veterinary guidance. -If tail self-mutilation recurs during or after fluoxetine withdrawal, recommend resuming fluoxetine for long-term maintenance +/- neurology and veterinary behavior consultation. -If tail self-mutilation recurs despite fluoxetine treatment, recommend neurology and veterinary behavior consultation. -Continue current CIRDC treatment/monitoring. -CTM tail closely for recurrence of self-trauma.

9/24/2026

Moved to new room, recheck S/O: QAR, appears to have eaten some wet food, no c/s/v/d noted EENT: Mild dried mucoid nasal discharge LUNGS: Eupneic MSI: Amb x 4, tail tip wnl with fur regrowth CNS: Appropriate mentation A: URI History of self trauma to tail requiring two separate amputations - currently leaving tail alone without e-collar Dental disease P: Monitor appetite and URI Recheck as scheduled Notes on kennel to notify behavior or vet services ASAP if licking/chewing on tail CTM closely on daily rounds