3/25/2025

[DVM Intake] DVM Intake Exam Estimated age: 1yr based on dentition Is this an orphan kitten? no microchip noted on intake? scanned negative History: owner surrender; reportedly constipated and went to vet for sedated deobstipation on 3/24/25 Subjective: BAR Observed Behavior - growling, trying to flee Is there evidence of Cruelty? no Is there evidence of Neglect? no Is there evidence of Trauma? no Objective P = 220 R = sniffing, eupneic BCS 4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: clean adult dentition PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated, no firm stool palpable in colon U/G: MI; 2 testicles descended MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: fecal staining around perineum Wood's Lamp Exam: not performed Assessment Approx. 1yr MI DSH Hx of constipation High FAS Prognosis: good pending response to treatment Plan: intake tasks Monitor in medical for signs of constipation/straining; placed monitoring sheet on kennel Canned food only Gabapentin 10mg/kg PO BID in case of discomfort from deobstipation If no BM in 48hrs consider diagnostics including bloodwork and abdominal radiographs SURGERY: Okay for surgery

3/26/2025

Recheck - recent reported history of deobstipation at outside vet S/O: QAR-BAR, timid, but warms and allows handling Not eating kibble or wet food, but eats churu readily No c/s/v/d noted, no stool in LB EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: SNP, firm stool palpable in colon - not abnormally hard or increased diameter MSI: Healthy haircoat, dried feces in fur caudally CNS: Appropriate mentation A: History of constipation/obstipation (reportedly deobstipated 3/24) P: Start medical feedings BID and CTM appetite Monitor closely for defecation

3/27/2025

Recheck constipation/obstipation S/O: BAR, appetite okay (some food eaten, not all) No c/s/v/d noted, no stool noted EENT: No ocular or nasal discharge LUNGS: Eupneic CNS: Appropriate mentation A: Constipation vs obstipation - reportedly deobstipated 3/24 P: CTM closely over next 24 hours - if no stool passed, recommend enema tomorrow.

3/27/2025

[Spay/Neuter Waiver - Temporary] Your newly adopted pet has been diagnosed with Constipation vs obstipation and the staff veterinarians are issuing a TEMPORARY waiver from the spay/neuter requirements of the City of NY. Follow up care at your regular veterinarian is recommended to ensure continued treatment through to the resolution of the issue. At the time of a full recovery you may choose to have your veterinarian perform the spay/neuter surgery, or make provisions to return the pet to ACC for sterilization.

3/28/2025

- Sedated w/ 0.08mls DexDom, 0.08mls Torb/ 0.08mls Ketamine IM - Abdomen rads taken - Deobstipation not needed - P neutered at time of sedation - 0.4 mls Onsior - SQ - Reveresed w/ 0.08mls Antisedan - IM - Returned to cage

3/28/2025

Recheck constipation/obstipation S/O: BAR, good appetite, no c/s/v/d noted No stool in LB this morning. (*Staff notified me that he did defecate later in the morning, at that time Patera was already sedated). EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: Tense, some regular firmness stool palpable in colon AXR: ingesta noted throughout GIT, some feces/fecal balls appreciated at distal colon/rectum; no constipation or obstipation appreciated A: Constipation vs obstipation - resolved P: Sedated with dexmedetomidine 0.01 mg/kg IM + butorphanol 0.2 mg/kg IM + ketamine 5 mg/kg IM Two view AXR Neuter Onsior 2 mg/kg SQ once Okay to move out of ICU, CTM while at QACC

3/28/2025

Routine Feline Neuter Single incision over midline of scrotum, sharp dissection to exteriorize each testicle Self tie of spermatic cords Green linear tattoo placed Surgeon: 1438 Additional Note: Smooth recovery

4/1/2025

Reported to be vocalizing while defecating. Log indicates defecation yesterday, none noted today. S/O: BAR, eating well, no v/d/s/c EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: Firm-hard feces palpable throughout colon, normal diameter A: Constipation P: Recheck tomorrow and consider enema if no defecation

4/2/2025

sedate for enema/rads with DVM ///Done

4/2/2025

Recheck constipation, reported to be vocalizing while attempting to defecate this morning. A few small hard pieces of stool reported in LB. S/O: BAR, good appetite, allows handling No c/s/v/d noted EENT: no ocular or nasal discharge LUNGS: Eupneic ABD: firm to hard feces palpable throughout colon Rectal: Hard ball of feces at rectum, unable to remove without breaking up Sedated for AXR and enema - dexmedetomidine 0.1 ml IM + butorphanol 0.1 ml IM. 2VAXR: Stool backed up throughout colon (ascending+descending), mildly increased diameter A: Constipation - ro dehydration (not appreciated on PE) vs electrolyte abnormalities vs neuro vs endocrine vs other P: Enema while sedated: Approx 40 ml of warm water + lubricant instilled via red rubber. Palpated abdomen and massaged colon to break up feces. Digitally broke down large fecal ball in rectum and removed. Start lactulose 0.5 ml/kg BID Start SQ LRS 100 ml SID x 4 days CBC/CHEM/T4 to idexx CTM in ICU for defecation

4/3/2025

Recheck constipation, given enema 4/2 S/O BAR, comes to the front of kennel, no c/s/v/d noted, no BM today, food trays empty EENT: no ocular or nasal dc HL: eupneic GA/GU: npm, tenses when abdomen palpated, small amount of stool palpable MSI: amb x 4, good skin turgor A. Constipation- enema 4/2, on lactulose P. Con't treatments as written CTM- brief recheck tomorrow -if no BM tomorrow will likely need repeated enema vs possible to get cisapride? BW results and recheck exam CBC: Hemoconcentration (51.4) r/o dehydration CHEM: sl hyperphosphatemia (6.4) r/o spurious vs age

4/4/2025

Recheck constipation S/O: BAR, good appetite, no defecation No c/s/v/d noted ABD: Large amount of hard stool palpated throughout colon, increased diameter RECTAL: large hard fecal ball obstructing/preventing digital exam Sedated with dex/torb/ket, intubated, and maintained on iso for rads and de-obstipation. AXR (pre): Obstipation - large diameter feces throughout LI Deobstipation: Using red rubber, instilled approx 40 ml warm water + lubricant into colon. Massaged intestines and broke apart hard feces. Instilled another ~20 ml warm water + lubricant, repeated massage, and then aspirated that volume back. Removed some feces digitally, but most feces unable to be milked down/removed. AXR (post): fecal margins softened, overall diameter improved, still a good amt of stool within colon A: Obstipation, recurring/chronic P: Sedated for rads and deobstipation as described above Feed canned diet only (ideally i/d diet) Add miralax 1/4 tsp BID in food Continue lactulose and SQF CTM closely in ICU for regular defecation

4/4/2025

Addendum- approx 1hr post enema/deobstipation, Pantera defecated large pile of feces in his LB

4/5/2025

Brief recheck - BAR, great appetite, feces in LB (several pieces), no c/s/v/d note, eupneic. Plan: Continue miralax, lactulose, and SQF. CTM for regular defecation. Seek placement for continued/long-term care.

4/6/2025

recheck constipation S/O BAR, A+A, no c/s/v noted, FS5 noted in litter box with some fecal staining in the kennel EENT: no ocular or nasal dc HL: eupneic GA/GU: npm- tense, MN MSI: amb x 4, good skin turgor A. Constipation - appears to have improved, stool produced overnight P. CTM in ICU Con't to seek placement recheck as scheduled

4/8/2025

Recheck obstipation - BAR, active and eating well, no defecation noted overnight/this morning, (last reported yesterday morning); abdomen is SNP with no palpable stool in colon. Plan: Continue with current treatment plan and CTM defecation closely on rounds.

4/10/2025

Recheck obstipation S/O: BAR, active, eating well, no defecation overnight and none noted on monitoring sheet yesterday Staff report vocalization while in the litterbox No c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupnic ABD: Tenses with touch, no masses palpated, no firm/hard stool palpated in colon A: Hx obstipation P: Increase miralax to 1/2 tsp BID Continue lactulose PO BID CTM closely and seek placement, would potentially benefit from GI motility drugs

4/10/2025

Noted to be straining throughout the day, given metoclopramide (5mg/mL) 0.5mg/kg SQ once.

4/12/2025

Recheck obstipation BAR in kennel; eating all of wet food extremely well. *Feces last observed on 4/7. P tense on abdominal palpation. Large semi-firm stool palpated throughout lower GI stract. A: Constipation - continued; last bowel movement on 4/7 P: Administered dexmed/ket/torb (0.08ml of each) IM. Deep sedation level achieved. Reversed with 1/2 dose of dexmedetomidine. Manually removed 2 large pellets of firm feces from colon. Administered 40ml soapy water and lube enema. *Extend lactulose until 4/20 *Continue miralax indefinitely *Start LRS SQ 100ml q24h x 5 days *Check for feces tomorrow in AM

4/13/2025

Progress exam Subjective: BAR, no c/s/v/d. Passed large amount of feces this morning Objective: Eyes: Clear bilaterally, no discharge Oronasal: No nasal discharge. Lungs: Eupneic GI: Soft, non painful. No palpable stool in colon. Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Neuro: Appropriate mentation. Assessment: -Recurrent constipation (r/o megacolon) Plan: -Continue miralax 1/2 tsp PO q12h indefinitely -Continue LRS 20 ml/kg SQ q24h until 4/15 -Continue lactulose 2 ml PO q12h until 4/20 -CTM in medical until miralax dose is sufficient to prevent re-obstipation

4/15/2025

Recheck obstipation/constipation, last enema given 4/12, passed stool 4/13. S/O: BAR, active, eating well No c/s/v/d noted, no stool overnight or today EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: SNP, no large palpable feces A: Constipation vs obstipation - recurring/chronic P: Continue lactulose Increase miralax to 3/4 tsp PO BID CTM closely for defecation