11/21/2024

It is the policy of ACC not to perform surgery on any animal over the age of 8-10 years due to the higher risks incurred in a shelter setting. The veterinarian is hereby issuing a permanent spay/neuter waiver, from the spay/neuter requirements of the City of NY due to the estimated age of this animal. ACC does recommend you consult with your veterinarian to determine if surgical sterilization is appropriate.

11/21/2024

DVM Intake Exam Estimated age: Approx 10yr based on PE, dentition, and ocular examination. Microchip noted on Intake? Scanned neative History: Agency Subjective: QAR in kennel, BAR in examination room. No v/d/c/s. Observed Behavior - Growling, purring, head butting. Is there evidence of Cruelty? No Is there evidence of Neglect? No Is there evidence of Trauma? No Objective - growling and hissing, does not allow abdomen to be palpated. Was able to perform cardiac/lung auscultation. Patient approved for sedation. Patient sedated with dexmeditomidine 10mcg/kg + butorphanol 0.2mg/kg IM. Adqeuate sedation achieved. T = NP P = 230 (pre-sedation) R = Growling/purring BCS = 5/9 EENT: Eyes: cornea clear, nuclear sclerosis OU, pinpoint cataracts OU, ears moderate accumulation of ceruminous debris AU, no nasal or ocular discharge noted Oral Exam: Heavy calculus accumulation on PMs/molars PLN: No enlargements noted H/L: tachycardic, NMA, CRT < 2, Lungs clear, eupneic ABD: Abdomen is distended. P Growls every time abdomen palpated, no masses, fluid wave, foreign body palpated. U/G: Intact female - mammary glands are small but cannot identify a spay scar. No obvious tattoo present. MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally normal Wood's Lamp Exam: NP Diagnostics: 1) CBC: - HCT: 30.2% (L) - MCV: 31.4 (L) - MCH: 11.5 (L) - MCHC 36.5 (H) - RDW: 28.1 (H) - Platelets: 101 (L) - Plateletcrit: 0.15% (L) 2) Chem: - Crea: 0.6 (L) - K+: 2.9 (L) - ALT: 180 (H) 3) T4: 7.2 (H) 4) aFAST: No free fluid present in abdomen. Urinary bladder intact and full. No evidence of stones/debris. No obvious distension of uterus - unable to visualize uterus. Kidneys appear to have normal corticomedullary junction bilaterally. Liver appears to have smooth, regular contour, homogeneous echogenicity with clearly visible blood vessels. Gallbladder appears WNL. Intestinal tract appears to have normal peristalsis. Stomach distended with mottled/heterogenous echogenicity within lumen (suspect food). No obvious obstructions/masses in stomach or in duodenum. 5) UA sample obtained via cystocentesis - pending 6) Two view Abd Radiographs: Spondylosis present at sacrococcygeal junction. Bladder very enlarged. Mass effect present in cranial abdomen, difficult to assess if enlarged stomach vs attached to the liver. Based on afast, suspect full stomach. Assessment: 1) Tachycardic - R/O stress, pain, electrolyte imbalance, hyperthyroidism, vs shock, vs other. 2) Abdominal distension - R/O secondary to large meal, abdominal mass, pyometra, pregnancy 3) Low HCT with increased RDW with microcytic RBCs: R/O iron deficiency, liver disease, hemorrhage, vs other. 4) Thrombocytopenic - r/o atifact, infection/inflammation, neoplasia 5) Decreased Crea: R/O secondary to hyperthyroidism vs other. 6) Hypokalemia - suspect secondary to hyperthyroidism vs spurious. R/o Gi vs renal losses vs other. 7) Elevated ALT: r/o secondary to hyperthyroidism vs liver disease, trauma, neoplasia 8) Hyperthyroidism 9) Distended stomach - suspect due to recent meal. Patient was not fed within our facility at time of examination so may have been fed just prior to intake. R/O outflow obstruction. Prognosis: Fair Plan: 1) Intake tasks performed 2) In-house bloodwork 3) UA collected via cysto and submitted to Idexx 4) Abdominal radiographs 5) Abdominal ultrasound 6) Start on gabapentin 100mg capsules (~20mg/kg) - 1 cap po BID x 7d. First dose tomorrow, 11/22am. 7) Start methimazole 2.5mg po BID x indefinitely 8) Recheck patient's demeanor overall tomorrow. Make sure not vomiting and that patient is eating. 9) Recheck bloodwork with a T4 in 2 weeks (12/5). Adjust methimazole accordingly. SURGERY: Permanent waiver due to age

11/22/2024

S/O -noted to possibly have painful abdomen on intake, blood work and rads wnl -BAR, noted to not be eating this am, but ate tiki cat when offered during exam, no c/s/v/d appreciated, FS3 in litterbox purring, grows if touching abdomen EENT: no ocular or nasal dc appreciated, mm pm <2 H/L: eupneic MSI: amb x 4, no apparent lesions or lameness noted A/P -hyperthyroid, started on methimazole yesterday -growling if abdomen palpated r/o behavior (imaging and bw wnl). CTM while at QACC, okay to leave medical with monitoring log. -General recheck in 1 week

11/22/2024

UA results: USG 1.024 1+ proteinuria A/P Hyperthyroid Recheck BW in 2 weeks (scheduled)

11/29/2024

Brief recheck, hyperthyroid cat S/O: BAR, eating well No c/s/v/d noted No ocular or nasal discharge Eupneic A: Hyperthyroid Dental disease P: Continue methimazole BID Recheck bloodwork as scheduled CTM while at QACC

12/5/2024

Sample collected and sent to IDEXX

12/6/2024

S/O -progress exam and BW interpretation -BAR, no c/s/v/d, fair-good appetite, seems to eat wet food not dry, multiple trays of uneaten meds in kennel. -Leans in for pets, purring loudly EENT: no ocular or nasal dc, mm pm <2 HL: nma, clear bilaterally MSI: good skin turgor, amb x 4 BLOOD WORK RESULTS: CBC: RBC H (11.65) CHEM: SDMA H (20) Creat L (0.7) TT4 H (7.6) A/P -P TT4 is still elevated, slightly increased from initial exam. Likely d/t p not taking meds rather than needing dosing adjustment -Con't on methimazole 2.5mg PO BID- tablets to be crushed in water and given directly into mouth -Recheck in 1 week +/- repeat BW aTT (vs in another week) to see if thyroid goes down. -repeat UA not scheduled aTT as UA prior was wnl and p has limited kitty minutes

12/10/2024

Brief recheck - not taking oral meds on her own, started crushing and mixing in water to give via syringe. Reportedly tolerating okay and gets *most* of medication. S/O: QAR, resting in LB No c/s/v/d noted Eating well Eupneic A: Hypertyroid - not controlled P: Looking into transdermal methimazole, cost may preclude use in shelter Continue with current treatment plan in meantime *Hyperthyroidism is a lifelong condition requiring a BID medication. I-131 therapy (radioiodine therapy) can be curative for some patients if pursued.