12/31/2017

DVM Intake Exam Estimated age: 1-2yrs Microchip noted on Intake? no History: O/S - convoluted hx Subjective: Cat is BARH Observed Behavior - immediately social, chirps. Allows limited handling; is extremely painful in hind end. Evidence of Cruelty seen - no Evidence of Trauma seen - yes Objective T = NA P = wnl R = wnl BCS 3-4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Grade 0-1/4 dental dz; fx of 104 and 204 PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: intact male, both testicles palpable scrotally; bladder large, but soft and able to express steady stream MSI: Ambulatory but appears to be knuckling on one or both hind feet, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum consistent bite wounds <10 days old. CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: has anal and tail tone; rectals wnl, no blood on glove Assessment: Multiple bite wounds of unknown origin; appear <10 days old. Lameness and/or neuro deficits pelvic limbs. Prognosis: Fair-Good Plan: Gave 0.42mLs Simbadol SQ, continue SID for additional 2 days. Sedated with 0.15mLs Telazol IM. Applied artificial tears OU. Lateral and VD pelvic radiographs. Clipped and scrubbed wounds. Mild pocketing, flushed with dilute chlorhexidine soln. Gave 0.33mLs Onsior SQ. SURGERY: Temporary waiver due to bite wounds and DOH hold.

1/2/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. Subjective: BARH. No c/s/v/d. Normal bm and u in litter box and is rubbing against the front of the cage purring and seeking attention. Does not seem painful even when examining bite wounds. Mild cachexia and ataxia in HLs. Objective P = wnl R = wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition with mild dental disease PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic, purring ABD: Non painful, no masses palpated U/G: MI MSI: Ambulatory x4 with cachexia in HLs and mild ataxia, no knuckling, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum to both sides laterally, area has been shaved, no active d/c, healthy granulation tissue, no swelling CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other Lameness and/or neuro deficits pelvic limbs-IMPROVED Prognosis: Good Plan: Continue clavamox until 1/10 Monitor puncture wounds daily DOH hold

1/3/2018

Monitor puncture wounds/ataxia S/O: BARH. Very active and attention seeking. Allows all handling. Eating well EENT: Eyes clear, no ocular or nasal discharge, pink mm HL: No sneezing, normal thoracic auscultation INTEG: Multiple healing wounds over caudal dorsum and base of tail- no swelling or discharge, healthy granulation tissue present MS/NEURO: Ambulatory x 4, mild ataxia, no knuckling UG: Male A: Healing wounds, ataxia P: Continue with current treatment and monitoring plan. Good prognosis

1/4/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. Subjective: BARH. No c/s/v/d. Normal bm and u in litter box and is rubbing against the front of the cage purring and seeking attention. Does not seem painful even when examining bite wounds. Mild cachexia and ataxia in HLs. Objective P = wnl R = wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition with mild dental disease PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic, purring ABD: Non painful, no masses palpated U/G: MI MSI: Ambulatory x4 with cachexia in HLs and mild ataxia, no knuckling, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum to both sides laterally, area has been shaved, no active d/c, healthy granulation tissue, no swelling CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other Lameness and/or neuro deficits pelvic limbs-IMPROVED Prognosis: Good Plan: Continue clavamox until 1/10 Monitor puncture wounds daily DOH hold

1/4/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. Subjective: BARH. No c/s/v/d. Normal bm and u in litter box and is rubbing against the front of the cage purring and seeking attention. Great appetite. Wounds are healing well. Objective P = wnl R = wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition with mild dental disease PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI MSI: Ambulatory x4 with cachexia in HLs, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum to both sides laterally, area has been shaved, no active d/c, healthy granulation tissue, no swelling CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other-healing well Lameness and/or neuro deficits pelvic limbs-RESOLVED Prognosis: Good Plan: Continue clavamox until 1/10 Monitor puncture wounds daily DOH hold

1/5/2018

Monitor wounds/ataxia in hindlimbs S/O: BARH. Attention seeking, allows all handling, eating well, soft stool in litterbox EENT: Pink mm, teeth clean, eyes clear, no ocular or nasal discharge HL: Normal thoracic auscultation, no sneezing ABD: Tense, no masses palpable, small bladder INTEG: Multiple healing wounds and scar tissue at caudal dorsum and base of tail all healing well; full thickness skin wound with healthy granulation tissue forming had skin/scab slough off, ~1.5cm around MS/NEURO: Ambulatory x 4, posture in hind end slightly hunched under, very mild ataxia, did not fall over today when walking UG: Male A: Healing wounds hind end ataxia improving soft stool today P: Continue with current treatment and monitoring plan. Good prognosis

1/6/2018

Monitor wounds/ataxia in hindlimbs S/O: BARH. Attention seeking, allows all handling, eating well, normal stool in litterbox, small amount of litter EENT: eyes clear, no ocular or nasal discharge HL: Normal RR/RE, no sneezing ABD: Tense, no masses palpable INTEG: Multiple healing wounds and scar tissue at caudal dorsum and base of tail all healing well; full thickness skin wound at left flank, caudal margin is thickened with dead tissue and has serosanguinous discharge, healthy granulation tissue at cranial margin MS/NEURO: Ambulatory x 4, posture in hind end slightly hunched under, very mild ataxia, did not fall over today when walking UG: Male A: Most wounds completely healed or healing well with the exception of one wound at the left flank showing signs of early infection and necrosis hind end ataxia improving P: Adding nolvasan to treatments. May require additional oral antibiotics +/- primary closure of wound. Continue with current treatment and monitoring plan. Good prognosis

1/7/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. 1/6-one of the wounds had serosanguineous d/c-started on nolvasan Subjective: BARH. No c/s/v/d. Normal bm and u in litter box. Good appetite. Objective P = wnl R = wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI MSI: Ambulatory x4 with cachexia in HLs, mild ataxia especially when using the litter box but did not fall over during exam, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum to both sides laterally, area has been shaved, no active d/c, wound on left flank has necrotic edges but no d/c, no swelling CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other Lameness and/or neuro deficits pelvic limbs Prognosis: Good Plan: Continue clavamox until 1/10 Continue nolvasan until 1/10 Monitor puncture wounds daily DOH hold

1/8/2018

[Progress Exam Template] S: bar O: easily moves from 1 part of cage to the other, but noticeably weak in hind due to decreased muscle mass, allowed exam EENT: overtly wnl Oral Exam: pink, mild tarter H/L: no overt murmur, fsp/clr lung fields Abd: no overt masses/pain, thin MSI: diffuse sarcopenia, but most pronounced hind end, bite wounds healing well, Left caudodorsolateral wound 1 cm x 1 cm w/ small piece of necrotic tissue <1/2 cm, but otherwise healthy tissue Mentation:bar A: bite injuries sarcopenia - secondary to trauma - likely more the issue than true neurologic P: may need debridedment of necrotic piece of tissue, continue to monitor for weight gain and return of muscle mass and loss of "ataxia" Is the Initial Medical Status being Changed? New Medical Status: Is the Initial Behavior Status being Changed? New Behavior Color:

1/9/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. 1/6-one of the wounds had serosanguineous d/c-started on nolvasan Subjective: BARH. No c/s/v/d. Normal u in litter box. Good appetite. Mild ataxia. Wounds healing well. Objective P = wnl R = wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral: Adult dentition, mild dental disease PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic, purring ABD: Non painful, no masses palpated U/G: MI MSI: Ambulatory x4 with cachexia in HLs, mild ataxia, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum to left side (right lateral wounds have healed), no active d/c, wound on left flank has a scab that is peeling off but no d/c, no swelling CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other Lameness and/or neuro deficits pelvic limbs Prognosis: Good Plan: Continue clavamox until 1/10 Continue nolvasan until 1/10 Monitor puncture wounds daily-left flank wound may need debridement in the future DOH hold

1/10/2018

Monitor wound healing, ataxia S/O: BAR. Active, attention seeking, eating well EENT: Eyes clear, no ocular or nasal discharge HL: no sneezing, normal RR/RE INTEG: Multiple healed wounds at caudal half of body and base of tail, ~1.5cm wound at right flank has flap of necrotic skin ventrally, healthy granulation tissue over wound, no swelling, no discharge noted MS: Ambulatory x 4, very mild ataxia UG: Male A: Wounds of unknown origin Ataxia - resolving well P: Continue with current treatment and monitoring plan. Good prognosis Wound at right flank may need debridement in future

1/11/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. 1/6-one of the wounds had serosanguineous d/c-started on nolvasan Subjective: BARH. No c/s/v/d. Normal u and bm in litter box. Good appetite. Mild ataxia. Wounds healing well but has some purulent d/c today. Objective P = wnl R = wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral: Adult dentition, mild dental disease PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic, purring ABD: Non painful, no masses palpated U/G: MI MSI: Ambulatory x4 with cachexia in HLs, mild ataxia, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum to left side (right lateral wounds have healed)-one open wound on left flank with mild purulent d/c and possible small pocket CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other Lameness and/or neuro deficits pelvic limbs Prognosis: Good Plan: Extend clavamox until 1/14 Extend nolvasan until 1/14 Monitor puncture wounds daily-left flank wound may need debridement and or primary closure in the future DOH hold

1/12/2018

Monitor wounds/ataxia S/O: BAR. Active, attention seeking. Eating well EENT: Eyes clear, no ocular or nasal discharge HL: No sneezing, normal RR/RE INTEG: All wound healed except for ~1cm wound at left flank: healthy granulation tissue forming, edges are dry with necrotic skin tag ventrally, no discharge or swelling MS: Ambulatory x 4, minimal hind limb ataxia noted, ambulating very well UG: Male A: Wound Ataxia - resolving well P: Continue with current treatment and monitoring plan. Wound may need to be debrided. Excellent prognosis

1/13/2018

Monitor wounds/ataxia S/O: BAR. Active, attention seeking. Eating well EENT: Eyes clear, no ocular or nasal discharge HL: No sneezing INTEG: Multiple healed wounds to caudal dorsum, one healing wound at left flank, healthy granulation tissue present, small tag of necrotic skin at ventral border MS: Ambulatory x 4, no ataxia noted UG: Male A: Majority of wounds healed, one open wound healing well Ataxia resolved P: Continue with current treatment and monitoring plan. Excellent prognosis

1/14/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. 1/6-one of the wounds had serosanguineous d/c-started on nolvasan Subjective: BARH. No c/s/v/d. Normal u in litter box. Good appetite. Mild ataxia. Wounds healing well. Objective P = wnl R = wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic, purring ABD: Non painful, no masses palpated U/G: MI MSI: Ambulatory x4 with cachexia in HLs, mild ataxia, skin free of parasites, no masses noted, multiple puncture wounds to caudal dorsum to left side (right lateral wounds have healed)-one open wound on left flank with no d/c-healing well CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other Lameness and/or neuro deficits pelvic limbs Prognosis: Good Plan: Last day of clavamox and nolvasan Monitor puncture wounds daily-left flank wound may need debridement and or primary closure in the future DOH hold

1/16/2018

Progress exam History: Intake 12/31 with multiple wounds of unknown origin. Sedated and area clipped/cleaned. Started on clavamox, simbadol, and given one dose of onsior. Pelvic rads nsf. 1/6-one of the wounds had serosanguineous d/c-started on nolvasan Subjective: BARH. No c/s/v/d. Normal u in litter box. Good appetite. Mild ataxia. Wounds healing well. Objective EENT: Eyes clear, no nasal or ocular discharge noted H/L: Eupneic U/G: MI MSI: Ambulatory x4 with cachexia in HLs, mild ataxia, skin free of parasites, no masses noted, one open wound on left flank with no d/c and healthy granulation bed-healing well CNS: Mentation appropriate Assessment: Multiple puncture wounds of unknown origin r/o bite wounds vs other Lameness and/or neuro deficits pelvic limbs Prognosis: Good Plan: CTM while at BACC Rec neuro consult DOH hold

Tiger was rushed back to medical due to his physical condition, minimal handling was done but he allowed counselor transfer and collar him.