12/21/2022

[DVM Intake] DVM Intake Exam Estimated age:5y Microchip noted on Intake?n History:stray Subjective: Observed Behavior -curious, calm for exam Evidence of Cruelty seen -n Evidence of Trauma seen -n Objective T = P =200 R =20 stertor BCS 7/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam:clean adult teeth PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G:female no ss seen MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment; stertor but wnl, overweight Prognosis:good Plan:Ohe pkay for surgery

12/26/2022

Progress Exam--URI signs seen on rounds. Subjective: BAR, no vomiting/diarrhea. Stertor as previously described. Mild sneezing throughout exam Objective: Cageside exam performed. Eyes: Mild serous nasal discharge Nasal Cavity: Mild stertor, mild serous nasal discharge. Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Neuro: Appropriate mentation. Assessment: -Mild URI Prognosis: Good Plan: -Start fortiflora 1 packet PO q24h x 7d until 1/2 -Placed feeding log -Cover cage, treat in place -Recheck day 10

1/5/2023

URI day 10 recheck S/O: BAR, leaning into petting Mild congestion, mild serous nasal discharge Sneezing, no c/v/d noted Food untouched, not interested in treats or kitten food when offered. A: URI, hyporexia P: Restart fortiflora PO SID x 7 days Start medical feedings BID x 5 days Start nebulization BID x 5 days Recheck appetite in 2 days, monitor on rounds, URI recheck day 14

1/6/2023

Noted poor appetite and progressing URI signs S/O QAR, food uneaten Eyes - OU moderate blepharospasm with mild mucoserous discharge Very mild serous nasal discharge Congestion audible A: URI - persisent/possibly progressing Conjunctivitis Hyporexia Overweight P: Start doxycycline 10 mg/kg PO SID x 10 days Start ofloxacin OU BID x 7 days Start SQ LRS 150 ml SID x 2 days Start cerenia 1 mg/kg SQ SID x 2 days Start mirtazipine transdermal SID x 2 days Continue medical feedings, fortiflora, and nebulization CTM on daily rounds

1/7/2023

Has not eaten for last 2-3 days S/O QAR, purring and affectionate Eyes - OU mild blepharospasm with mild mucoserous discharge Mouth - no oral discharge, no obvious ulcers on brief exam Very mild serous nasal discharge Congestion audible A: URI - severe Conjunctivitis Hyporexia Overweight P: Move to medical for closer monitoring Continue doxycycline 10 mg/kg PO SID until 1/16 Continue ofloxacin OU BID until 1/13 Extend SQ LRS 150 ml SID until 1/10 Extend cerenia 1 mg/kg SQ SID until 1/10 Start Elura 2 mg/kg PO q24 until 1/10 Continue medical feedings and nebulization until 1/10 CTM on daily rounds

1/9/2023

Hx: Severe URI, has not eaten in 3-4 days S: QAR. ~5% dehydrated. Sneezing. NI in food. No cvd/ Eyes: Mild to moderate ocular serous discharge OU Ears: Unremarkable AU. Nasal Cavity: mild serous nasal discharge Oral Cavity: Mild to moderate dental tarta PLN: WNL Heart: No murmurs or arrhythmias. Pulses strong and synchronous. Lungs: Moderate stertor, Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated. Musculoskeletal: Ambulatory x 4 with no appreciable lameness. BCS = 7/9 Integument: Otherwise unremarkable haircoat. Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. Assessment: URI - severe Conjunctivitis Anorexia Overweight Plan: Continue doxycycline 10 mg/kg PO SID until 1/16 Continue ofloxacin OU BID until 1/13 Extend SQ LRS 150 ml SID until 1/14 Extend cerenia 1 mg/kg SQ SID until 1/14 Start Elura 2 mg/kg PO q24 until 1/10 Continue medical feedings and nebulization until 1/14 Due to being overweight and anorexic, high risk for HL- recommend placement of E-tube tomorrow

1/10/2023

Patient BAR and very friendly. Did not eat overnight but licked a small amount of wet food with petting. Plan: Start simbadol 0.12 mg/kg SQ q24 until 1/12- first dose given Extend Elura 2 mg/kg PO q24 until 1/12 Restart Mirataz 1.5 in strip to ear q24 until 1/12 If not eating tomorrow, place e-tube

1/13/2023

Patient BAR and friendly with moderate congestion. Nibbled tiny amount of food overnight Patient sedated with dexdomitor 10 mcg/kg IM and butorphanol 0.2 mg/kg IM, intubated, and maintained on isoflurane and oxygen. Feeding Tube: The left side of the neck was clipped and aseptically prepped. A curved Carmalt was inserted into the esophagus and pushed towards the left lateral aspect of the esophagus, and an incision was made over the tip using a #10 blade. The feeding tube was clamped in the hemostats, pulled out through the mouth, then redirected down the esophagus towards the stomach. Radiographs were obtained to check for correct placement. The tube was then secured using a finger trap suture and wrapped with a padded bandage. Note: Towards end of procedure, patient was noted to have mydriatic right pupil. Patient had smooth recovery with normal pupils once awake; PLRs and menace intact OU. Plan: Feed 1/3x RER today, 2/3x RER tomorrow, 1x RER 1/14- instructions posted on cage Extend Cerenia 1 mg/kg SQ q24 until 1/15 Extend LRS 150 ml SQ q24 until 1/15 Extend nebulization q12 until 1/15 Extend Elura 2 mg/kg via tube q24 until 1/15 Continue doxycycline until 1/16 Recheck tomorrow Addendum: Patient began hypersalivating with foam during tube feeding (done in evening, ~6 hours after procedure). Gave Cerenia 1 mg/kg SQ and posted sign to feed very slowly and monitor for signs of nausea. Hypersalivation resolved.

1/14/2023

Recheck anorexia w feeding tube, severe URI S/O: BAR at front of kennel, leans into petting Not eating on her own, but tolerating tube feedings well No c/s/v/d noted Moderate-severe crusted discharge obscuring nares with mild sores/ulcerations at nasal planum Mild congestion No ocular discharge, pupils symmetrical Normal respiratory rate and effort A: Severe URI Anorexia with feeding tube Overweight P: Continue nebulization, medical feedings, ofloxacin, doxycycline, cerenia, elura Continue offering food first and if not eating, feed via e-tube CTM in medical

1/17/2023

Recheck anorexia/URI, e-tube in place S/O: BAR, eating medical feeding tray! Congestion noted with mild mucoid nasal discharge No ocular discharge Normal resp rate and effort A: URI Anorexia - improving! P: Continue to offer food first, tube feed if not eating. Extend doxycycline until 1/22 CTM while at BACC

Upon intake: They were meowing loudly while in admissions. She allowed staff to collar, take pictures, and pet her. She had a high tail, and allowed staff to pick her up. She accepted food. She was then taken to medical.