11/9/2023

DVM Intake Exam Estimated age: 2 yr Microchip noted on Intake? positive History: owner surrender, urinary blockage evaluated at ER facility just prior to intake Subjective: owner surrender Observed Behavior -very lethargic Is there evidence of Cruelty?none Is there evidence of Neglect?none Is there evidence of Trauma?none Objective Quiet responsive, moderate dehydration trembling, sternally recumbent P =220 R = sniffing BCS 6/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: NSF oral PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: moderate sized urinary bladder, unexpressible MSI: nonambulatory, skin free of parasites, no masses noted, unkempt oily coat, muscle trembles hind limbs soem scratches on ventrum CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal:not performed Assessment urinary blockage azotemia normal potassium Prognosis: guarded Plan: CBC: HCT 43.4%, NEYT 13.00, PLT 277 CHEM: BG 245, BUN 76, SDMA 24, CREAT not readable, potassium 4.1 sedated IM: dexdomitor/ketamine/torb 0.1ml each needed additional torb 0.1ml IV anesthetized with IV propofol ( total 1 ml), maintained with iso via mask IV catheter RF 22 gauge. bolused 50ml LRS, continue on 20ml/hr until overnight, then lower to 10mls/hr No abs were given Simbadol 0.63ml SC ABD XR: excellent serosal detail, moderate sized, uniformly radiopaque urinary bladder, no stones seen urinary catheter sutured to tape stay/ preputial skin. Closed collection system attached urethral catheterization: retropulsed saline with 3.5 fr red rubber, large mount of sandy grit completely blocked urethra e collar placed. continue to monitor.

11/9/2023

check up: Pet is active, eats Churru urinary cath and IV cath lines tangled together, u- cath not flowing well. The lines were untangled which released urine to flow to bag. IV fluid rate dropped from 20mg/hr to 10ml/hr

11/10/2023

Recheck UO S/O: QAR, allows handling, growls when prepuce examined Ate some food overnight IV fluids turned off overnight, restarted this morning Approx 50 ml of hematuric urine in collection system, does not appear to be taking on more urine this morning (checked an hour later and volume unchanged) Moderate sized, moderate firmness urinary bladder palpted A: UO - suspect urinary catheter obstructed Azotemia Overweight P: Sedated with dexmedetomine 0.1 ml IM, butorphanol 0.1 ml IM, ketamine 0.1 ml IM. -Confirmed urinary catheter not patent, able to flush with saline and unblock -Elected to place new U-cath (5Fr instead of 3.5Fr) to prevent re-blocking -Removed first u-cath with moderate resistance, had to retropulse with sterile saline to remove -New u-cath (myla 5 Fr) place with some resistance, again had to retropulse sterile saline to advance Lateral AXR confirmed placement of u-cath, secured with 3-0 PDS. Zorbium applied Continue IV LRS @ 1.5 times maintenance (14 ml/hr) Scheduled repeat chem in house tomorrow, if azotemia resolved, consider onsior CTM closely in medical

11/11/2023

Progress exam Subjective: QAR, no c/s/v/d. No interest in food today, hiding in litterbox. Euhydrated. Objective: Eyes: Clear bilaterally, no discharge Nasal Cavity: No nasal discharge. Lungs: Eupneic UG: Urinary catheter patent, bladder small and soft--patient splints during palpation but tolerates exam. 240 ml of mildly hemorrhagic urine produced overnight, ~60 ml produced over next 8 hours Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Neuro: Appropriate mentation. Chemistry: All values WNL Assessment: -Post blockage diuresis (appears to have slowed after changing bag in AM) -Azotemia (resolved) -Anorexia (likely high FAS secondary to shelter environment, urinary catheter) Plan: -Start gabapentin 20 mg/kg PO q12h x 14d until 11/25 -Decreased fluids to 10 ml/hr (maintenance rate) -CTM closely in medical

11/12/2023

Progress exam-recheck FLUTD/obstructed SO: QAR no c/s/v/d. Food looks untouched, not interested in food that was offered (treats + KF, he did sniff the dry Friskies treats) IVC turned off overnight. Hiding in the back of kennel, will low growl when approached but no other signs of escalation. EENT: No ocular/nasal discharge L: Eupneic, normal RR/effort, no abdominal component ABD: No obvious distention MSI: Ambulatory x 4 with no appreciable lameness U/G: ~100ml of mildly hemorrhagic urine produced overnight, new urine currently being produced is more normal in color CNS: Cranial nerves intact-full neuro exam not performed A: FLUTD with obstruction (unblocked 11/9) Anorexia (likely high FAS secondary to shelter environment, urinary catheter) P: CTM while at BACC Continue gabapentin 20mg/kg PO BID x 14 days until 11/25 Start mirtazapine 1.5inch topically SID x 4 days-first dose applied (elected to try topical over oral meds due to high FAS, may have to switch to elura if P not eating) Continue IVF 10ml/kg Start medical feedings BID x 5 days Overall recheck tomorrow

11/13/2023

Recheck UO Patient QAR to BAR. Did not eat overnight, no interest in offered food. Urinary collection bag has ~160 ml hemorrhagic urine. Catheter in place and patient urinating around it- moderate amount urine over hind end. Attempted to remove catheter- unable to do so, feels stuck in urethra. Sedated with dexdomitor 10 mcg/kg and butorphanol 0.2 mg/kg IV for further evaluation. 2v AXR- one lateral, one lateral with hind legs pulled forward to assess urethra- no stones noted. Catheter in bladder resting against wall. No bends or kinks noted in catheter. Brief focused ultrasound- contents of urinary bladder moderately echogenic. Gravity-dependent shadowing material present. When bladder jiggled, shadowing material disperses throughout bladder- consistent with grit/debris, not stones. Bladder appears intact. Under sedation, urinary catheter patent- moderate hemorrhagic urine collected from catheter via syringe. Urinary bladder small and soft. Able to flush saline retrograde into bladder. Unable to significantly move catheter proximally or distally in urethra. Moved catheter slightly distally d/t position in bladder. No bruising noted- low suspicion for ruptured urethra. Re-sutured catheter into place and reattached urinary collection system. Plan: - Unable to remove catheter, elected to re-suture to prepuce. Monitored throughout day, confirmed catheter patent and urine flowing. Suspect catheter lodged d/t excessive grit and inflammation in urethra. - Radiographs and focused ultrasound- see above - Removed "feed wet only" sign- ok to offer any food until patient eating consistently - Repeat Zorbium tomorrow - Continue IVF - Discontinue gabapentin- not consuming - CTM closely in medical, recheck tomorrow

11/14/2023

Recheck cat with recent UO Patient BAR and euhydrated. Pulled catheter out on own overnight. Did not eat but was reported to eat small amount yesterday. Urinated and defecated. A: Recent UO, possible FIC Anorexia P: -Removed IVC and e-collar -Ok to d/c IVF -Gave Convenia 8 mg/kg SQ once due to extended period of time with u-cath -Continue current treatment plan, monitor closely on daily rounds and recheck in two days

11/15/2023

Brief recheck: Patient BAR. Urinated in litter box and ate small amount of food overnight! Briefly observed straining in box during day, but later urinated in litter box. Again, ate small amount. - CTM closely in medical - Start urinary diet once patient eating consistently - Seek placement as soon as possible- patient does not need hospitalization at this point as long as he continues to do well, but would benefit from less stressful environment

11/18/2023

Recheck FLUTD, history of UO S/O: QAR, flees to the back when approached, growling when examined, but does not escalate. Ate well overnight, med feeding tray empty Urine in litterbox, UB not easily palpated No c/s/v/d noted, eupneic Kennel messy with soiled bedding, feces noted smashed up in bedding A: FLUTD, UO x 1 P: Extend medical feedings, consider restarting gabapentin once eating well regularly CTM closely while at BACC

11/20/2023

Recheck cat with recent UO Patient BAR in kennel, growls when approached. Yesterday, urinated normally in litter box and ate all food. Only ate portion of medical feeding last night. Normal stool in litter box. No urine present. Monitoring log shows patient did not urinate overnight. On physical exam, patient stressed but not painful on bladder palpation. Bladder moderate in size, soft, and expressible. Urine appropriately concentrated with no gross hematuria noted. Plan: No changes to treatment plan CTM closely in medical, start urinary diet and gabapentin once eating more consistently

11/28/2023

Brief recheck - QAR at back of kennel, eating well, urinating in LB, no c/s/v/d noted. A: Hx UO P: Start gabapentin 20 mg/kg PO BID and CTM closely while at BACC; recommend canned prescription urinary diet with placement

11/30/2023

Recheck cat with recent UO Patient BAR and fearful at back of cage- hisses when approached. Eating food and gabapentin well. Urinating consistently. Plan: -Ok to move out of medical -Move out with litter box monitoring sheet- CTM closely for urinary signs -Continue gabapentin and wet food only diet indefinitely

12/2/2023

Brief recheck, moved out of medical - BAR, hisses/growls when approached, urine in litterbox, eating, no c/s/v/d noted. Plan: Continue gabapentin, CTM closely on daily rounds, monitor appetite and urination. *Long-term - recommend canned urinary diet to minimize risk of urinary issues and/or urethral obstruction in future.

upon intake: due to the blockage he was rushed to medical and not handled.