12/22/2017

[DVM Intake] DVM Intake Exam Estimated age: Microchip noted on Intake? History : Subjective: Stray cat found in building stairwell Observed Behavior - Very sweet, allowed exam, temp and clipping of abd to check for evidence of spay (to a point) without struggling Evidence of Cruelty seen - None observed Evidence of Trauma seen - None observed Objective T = P = 200 R = wnl BCS 2/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: nsf PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: FI no evidence of spay scar or tattoo MSI: Ambulatory x 4, skin free of parasites, no masses noted, scaley coat, diarrhea/fecal material on paws, minimal palpable fat, prominent long bones and spine CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: underwgt r/o nutritional, gi dz (parasites, inf other) diarrhea r/o parasites, nutritional other Parvo cite neg Prognosis: good if can gain weight Plan: TID feedings Metronidazole 50 mg/ml 0.4 ml po bid x 10 days Vet recheck in 1 week prespay SURGERY: Temporary waiver due to underwgt and diarrhea

12/23/2017

[Progress Exam Template] S: QAR O: underweight and tx for diarrhea of unknown origin EENT:wnl Oral Exam: wnl H/L:no murmur/no arrythmia, fsp, 5% dehydrated Abd:thickened gi loops MSI: thin w/ decreased muscle mass Mentation:bar A: r/o malnourished vs endopara vs other inflammation P: 100 cc lrs sq continue to monitor weight Is the Initial Medical Status being Changed? New Medical Status:n Is the Initial Behavior Status being Changed? New Behavior Color: n

12/26/2017

Hx: Underweight, diarrhea, suspected parasitism. Given metronidazole and dewormed appropriately; later noted to be dehydrated so pt was given SQF. S: Alert in kennel, compliant for exam O: QAR, estimated 8-10% dehydrated based on decreased skin turgor, BCS 1-2/9 EENT: No discharge OU, AU, nose H/L: Eupnic, quiet lung sounds. NSR, NMA. Abd: Soft, nonpainful M/S/I: Amb x4, no lesions noted UG: Female Neuro: Mentally appropriate, no sign neurological deficits A: Emaciation, dehydration - R/O IBD, neoplasia, parasitism, metabolic disease, other P: 1. Bring down to medical 2. Run CBC/chem/T4 3. Start IV LRS at 15 ml/hr 1088

12/27/2017

Hx: Came in to shelter underweight and with diarrhea - R/O parasites; pt was dewormed and started on metronidazole. Today pt was dehydrated and she continues to be underweight and dehydrated despite TID canned food. Pt brought down to Medical and an IVC was placed for fluid resuscitation. CBC: Hct 32.4%, WBC 4.83 k/ul, plt 10 k/ul - R/O lab error vs. consumption (GI blood loss) despite normal Hct and no evidence of RBC regeneration Chemistry - creat slightly decreased, alk phos decreased, cholesterol decreased. R/O low glucocorticoids vs. GI parasites vs. liver shunt vs. other Plan: 1. Dexamethasone SP 0.2 ml SQ 2. Praziquantel being administered this evening 3. If pt relapses again, recommend further testing for endocrine disease/other 1088

12/27/2017

Hx: underweight with diarrhea on intake and was started on metronidazole and SQF; yesterday noted to be dehydrated and still underweight despite TID feeding; given praziquantal, dexamethasone and started on IVF at 15 ml/hr S/O -QAR, shy but docile and sweet -appears interested in food and approaches but then backs away; offered different flavor and she took a few licks -mm pk/lgt pk, sl tacky; mild hypersalivation, no obvious oral ulcerations -no nasal discharge or sneezing -OU: open and clear -eupnic -soft, nonpainful, doughy abdomen -underweight, BCS 3.5/9 A 1. Dehydration, improving 2. Diarrhea-none seen this morning, r/o parasites vs IBD vs other 3. Underweight 4. Inappetance, suspect mild nausea P -decrease IVF to 10 ml/hr, reassess rate in AM -cerenia 0.3 ml IV SID x 3 days, first dose given -continue metronidazole

12/28/2017

Hx: underweight with diarrhea, started on IVF due to dehydration on 12/26 and was also given dexamethasone injection and praziquantal due to severe, persistent diarrhea; also on cerenia and metronidazole; IVF running at 10 ml/hr today S/O -BAR, much more interactive today! very affectionate -good appetite, fed RC Selected Protein PR canned -small to moderate urination in box, no bowel movement overnight -mm lgt pk, moist -no nasal discharge or sneezing -OU: open and clear -eupnic -soft, nonpainful, doughy abdomen -underweight A 1. Diarrhea-none seen for 2 days, r/o severe parasite load vs IBD vs other 2. Underweight-r/o parasites vs IBD vs other P -okay to d/c IVF today -recommend diet trial with novel protein diet such as RC PR (potato and rabbit) vs z/d or RC hypoallergenic; will feed PR in shelter

12/29/2017

Recheck in medical for hx of underweight/diarrhea: S/O: BAR, frienldy, mildly dehydrated, BCS 2/9 - e/d u/d all ok - EENT clean/clear - H/L nsf - amb x 4, overall poor/skinny BCS; snp. abdomen A: no diarrhea observed, poor BCS r/o severe parasite load vs IBD vs other P: CWCT (currently being fed PR diet), monitor weight gain and bowel movements

12/30/2017

Recheck in medical for hx of underweight/diarrhea: S/O: QAR + mod. dehydrated this AM - poss. vomit of wet food this morning, mild hypersalivation observed - EENT clean/clear - H/L nsf - amb x 4, overall poor/skinny BCS; snp. abdomen A: no diarrhea observed today but possibly vomited this AM + mod. dehydrated P: CWCT + placed back on IV LRS @ 7 ml/hr and reassess tomorrow *appears much brighter after starting IVF

12/31/2017

Recheck in medical for hx of underweight + v/d?: IVF LRS @ 7 ml/hr S/O: QAR + mildly dehydrated this AM - eats soft food well, esp. after handling, will come to front of the cage for attention - no vomit observed; urine in litter, no feces - EENT clean/clear, no c/s - H/L nsf - amb x 4, overall poor/skinny BCS; snp. abdomen A: no vomit observed this AM, has good appetite + mildly dehydrated P: CWCT + incr. IV LRS to 9 ml/hr and reassess tomorrow

1/3/2018

Hx: Diarrhea, dehydration. Seemed to respond to dexamethasone SP and to IVF but became dehydrated when IVC pulled. No change with metronidazole or praziquantel. Being fed Royal Canin selected protein potato and rabbit. Urine in litterbox, no stool. S: Comes to the front of the kennel. Social eater - good appetite this morning. Allows all handling. O: BAR, estimated 5% dehydrated based on decreased skin turgor. BCS 3/9. EENT: No ocular discharge, nose is moist. Clean adult teeth. H/L: NSR, NMA. Sneezing. Quiet lung sounds. Abd: Soft, nonpainful. Intestines slightly thickened. M/S/I: Soft fatty non-reducible umbilical hernia today. A: 1. Diarrhea, vomiting, poor weight gain - R/O IBD vs. food sensitivity vs. pericardial-diaphragmatic-hernia vs. other 2. URI 3. Umbilical hernia P: 1. Move to med iso 2. Pull IVC, start LRS 50 ml SQ SID 3. Take abd and chest rads 4. Recommend abd ultrasound 1088

1/3/2018

S/O -QAR, less interactive than normal -good appetite, no diarrhea noted; small urination in box -mm pk, tacky; moderate hypersalivation, no oral ulcerations noted -excessive serous nasal discharge with congestion -eupnic, referred upper airway noise -soft, doughy abdomen; intestines sl thickened A 1. Diarrhea, poor BCS, intestinal thickening-r/o IBD vs other 2. URI-suspect viral 3. Dehydration-r/o URI vs other 4. Hypersalivation-r/o URI vs nausea (not suspected due to good appetite) P -cerenia .3 ml SQ SID x 3 days -nebulize SID x 3 days -continue SQF

1/5/2018

Hx: severe diarrhea that was minimally responsive to metronidazole and deworming; given dexamethasone injection on 12/27 and seemed to significantly improve, no diarrhea reported since; diagnosed with URI on 1/2 and moved to med iso S/O -QAR, less interactive than normal -good appetite, urine in box, no feces -mm pk, moderate hypersalivation -severe serous nasal discharge, nasal congestion -OU: mild blepharospasm -eupnic, clear lungs -soft, doughy abdomen A 1. URI 2. h/o diarrhea-r/o IBD vs parasites vs other 3. Underweight P -add cerenia 0.3 ml SQ SID x 3 days -continue other treatments -suspect IBD that appears to be responding to steroids, diet trial but abdominal ultrasound may be warranted after placement

1/5/2018

2 view full body radiographs available for review: Thorax-overall normal, cardiac silhouette WNL, no diaphragmatic hernia noted; Abdomen-decreased serosal detail due to BCS, large amount of ingesta in stomach, large amount of normal fecal material in colon A 1. Decreased serosal detail-r/o secondary to decreased BCS vs ascites (not suspected) vs other P -Monitor bowel movement, consider enema tomorrow if does not pass stool

1/5/2018

S/O -QAR, docile but less interactive -mm pk, sl tacky; no significant hypersalivation today -mild serous nasal discharge, nasal congestion -eupnic -soft, doughy abdomen, no palpable abnormalities A 1. Diarrhea-resolved 2. URI-suspect viral 3. Underweight P -CWCT

1/6/2018

re wt from 4.3 to 4.0