12/1/2022

DVM Intake Exam Estimated age: 10 yr Microchip noted on Intake? positive History:owner surrender, long stranding hindlimb weakness per owner Subjective:owner surrender Observed Behavior -friendly, head butts Evidence of Cruelty seen -none Evidence of Trauma seen -none large amount of urine and feces in kennel Objective BARH mm pink, tacky P = WNL R = WNL BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: heavy dental plaque and moderate tartar, hypererupted canines PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G:neutered male MSI: Ambulatory x 4, moderte ataxia and plantar stance pelvic limbs, generalized muscle atrophy skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate, paraparesis Rectal:not performed Assessment pu/pd muscle atrophy neuropathy uncomplicated DM Prognosis:fair Plan: move to medical start vetsulin one unit SC in pm CBC: HCT 44.4% NEUT 8.38 CHEM: ALT 136 H, BG 610 H, BUN 38 H LYTES WNL no urine collected

12/3/2022

Progress Exam - Diabetes S/O: BAR, leans into petting, eating well, no c/s/v/d noted. EENT: Eyes clear, no nasal discharge noted H/L: Eupneic, normal respiratory rate/effort ABD: No obvious distention MSI: Ambulatory x 4 with bilateral hindlimb weakness/lameness - pelvic limbs will splay occasionally, dropped hocks bilaterally; dorsal muscle atrophy appreciated CNS: Mentation appropriate A: Diabetes mellitus Dropped hocks, pelvic limb lameness - ro diabetic neuropathy vs other Dental disease P: D/c vetsulin, start PZI 1 unit SQ BID indefinitely Check BG in PM for one week, if stable okay to d/c BG checks Monitor appetite, overall condition closely in medical

12/7/2022

Recheck diabetes, HL ataxia/weakness - BAR and eating very well; HL ataxia/plantar stance largely unchanged. Plan: Continue with current treatment plan and recheck before d/c BG checks.

12/12/2022

Patient BAR, friendly. Excellent appetite. Polyneuropathy as previously described. Consistent, severe hyperglycemia on 1 u insulin BID: most recent BGs are 605 and 649; lowest since intake is 414. Plan: Increase insulin to 2 units PZI BID indefinitely Continue daily BG checks in evening until 12/19 Monitor on daily rounds Recheck 12/19- adjust insulin dose vs. discontinue daily BG checks

Upon intake: They were brought into ACC within a cardboard box. When staff opened it they allowed staff to pick them up. They do not have much strength in their hind legs, and smooth surfaces made it hard for him to walk within his carrier. He accepted food given, and allowed staff to collar them as well. When going back into their carrier they slipped and lost their balance, and walked into their carrier. Staff then took them back to medical within their carrier.