6/4/2026

[Spay/Neuter Waiver - Temporary] Your newly adopted pet has been diagnosed with (DEMODEX) 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.

6/4/2026

DVM Intake Exam Estimated age: 2 yr Microchip noted on Intake? negative History:stray Subjective:stray, posturing / tenesmus on intake Observed Behavior -depressed. wags tail and has soft eye Is there evidence of suspected cruelty? none Objective: QAR moderte dehydration mm pink, hyperemic P = WNL R = WNL BCS 3/9 EENT: Eyes heavy mucoid dischargfe and eyelid erythema/chemosis OU ears clean,entire dermis including face, ears muzzle hypotrichosis, scin flakes no nasal or ocular discharge noted Oral Exam: mild dental tartar PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G:scrotal testes MSI: Ambulatory x 4 weakly, entire dermis flaky, hypotrichosis, skin indurated especially on all four limbs and paws. All nail overgrown CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal:not performed Assessment: GI distress r/o secondary to renal failure r/oinfection, toxin, inflammation demodex dermatitis, extensive underweight severe azotemia BUN 108, CREAT 5.0 hypernatremia hyperphosphatemia hypoglycemia hyperproteinemia, hyperglobulinemia elevated ALKP Prognosis:poor Plan: skin scrape- positive for demodex CBC: HCT 41.1%, NeuT 11, monocytosis 2.16, eosinopenia 0.02, mild thrombocytopenia 193 CHEM lytes: BG 66, BUN 108, CREAT 5. PHOS 9.2, Na 174, GLOB 5.8,TP 8.5, ALPK 259 UA free catch to Idexx parvo snap and lepto snap negative place IV CATHETER LRS 300ml bolus IV fluids: LRS 100ml/hr IV: Cerenia 1mg/kg, 2.5ml, famotidine 1mg/kg 2.5ml SC: vit B12 0.5ml,convenia 2ml, ondansetron 0.2mg/kg SC ( 2ml) total volume about 500ml SURGERY: Temporary waiver due to sickness

6/4/2026

recheck: pet ate well, no vomit or diarrhea in kennel. Seems brighter capped off IV fluids for the night ( total volume given about 500ml V), plan to restart at 100ml/hr tomorrow 6/5/26 and 6/6/26, then recheck renal values

6/5/2026

Catheter replaced and restarted on fluids (60 ml/hr) per 2065. // Completed

6/5/2026

Progress exam On IVFT for severe azotemia and elevated creatinine Severe generalized dermatitis due to demodex; treated with Nexgard at intake 6/4 S/O: P is eating all of food when offered, no V/D/C/S. Kinks IV catheter regularly. QAR in kennel, low head carriage and wags tail when approached. Allows all handling and leans into head rubs. Pink and moist mm, crt<1-2 sections. Mild-moderate amount of dried/crusty mucoid discharge present around eyes. Generalized dermatitis as reported previously with epidermal collarettes, scabs and flakes. A: Eating well Severe dermatitis and pyoderma Demodicosis Underweight Dehdyration - resolving Vomiting - none observed today Severe azotemia (on 6/4 BUN 108, creat 5) r/o pre-renal vs renal Hypernatremia, hyperphosphatemia Hyperglobulinemia r/o inflammatory P: Start antibiotics for skin disease -Cefpodoxime 200mg PO q24h x 14 days *Ok to remove IV catheter *Start LRS SQ 500ml q24h x 5 days *Recommend bath when possible with Malaseb/Vetraseb *Repeat biochemistry on 6/6 to reassess renal values *CTM daily on rounds

6/7/2026

Repeat labwork and recheck exam CBC 6/6 HCT 39.7 Retic 3.0 low Lymph 0.38 low Mono 1.6 high Eosin 0.04 low Platelets 142 low CHEMISTRY: SDMA 46 V HIGH Creat 4.5 HIGH (5) BUN 87 HIGH (108) Phosph 8.8 high (9.2) Sodium 173 high (174) Chlor 134 high (136) Glob 4.8 high (5.8) TT4 1.1 WNL URINALYSIS 6/5 Free catch USG 1.020 LOW pH 5.5 LOW Blood/hgb 2+ RBCs 15-20 Epith 2+(3-5)/hpf Sperm present S/O: P is QAR, very friendly and sweet. Eating consistently well. Mild ocular discharge OU. Skin condition remains the same previously noted. A: Elevated SDMA Azotemia - improving Elevated creatinine - improving Hypernatremia - continued Hyperchloridemia - continued Elevated ALP - resolved Eating well P: Increase fluids to LRS 1000ml SQ q24h Add gabapentin 300mg PO q12h for analgesia (15mg/kg) *CTM on rounds and add in anti-nausea medications and GI protectants as needed *Recheck renal values in another 2 days, biochemistry only *If deteriorates recommend EHR; prognosis remains guarded

6/8/2026

Pull bloodwork for in-house Biochemistry please - recheck renal values Blood collected and run.

6/8/2026

CHEM - Elevated SDMA 44 (vs 46 on 6/6) - Elevated Creat 3.7 (vs 4.5 on 6/6) - Elevated BUN 99 (vs 87 on 6/6) - Elevated phosphorus 7.7 (vs 8.8 on 6/6) - Elevated sodium 167 (vs 173 on 6/6) - Elevated chloride 128 (vs 134 on 6/6) - Low albumin 2.1 (vs 2.4 on 6/6) - Normal globulin 4.3 (vs 4.8 on 6/6) - Mild elevated ALP 214 (vs 170 on 6/6) BAR Full food bowls in kennel but finished all food during exam EENT: Mild white mucoid discharge OU, no blepharospasm or chemosis, no nasal discharge or congestion H/L: Eupneic, normal RR MSI: Skin static, mildly gelatinous turgor (received SQ fluids) CNS: Normal mentation Assessment: Elevated SDMA - improving Elevated creatinine - improving Elevated BUN - increasing today Hyperphosphatemia - improving Hypernatremia - improving Hyperchloremia - improving Low albumin High globulins - resolved Mild elevated ALP - recurrent Plan: Continue supportive care Continue to monitor renal values, repeat chemistry in ~2 days EHR if declines in care or not showing significant improvement

6/10/2026

Recheck biochemistry in house - rechecking renal values ///Done

6/10/2026

Recheck severe azotemia, demodicosis, etc; gained about 8 lbs since intake S/O: QAR, great appetite, no c/s/v/d noted EENT: Mild white/gray mucoid discharge OU, no nasal discharge ORAL: mm pink and moist, CRT <2; mod tartar visible LUNGS: Eupneic MSI: Diffuse dermatitis/alopecia as previously noted - stable CNS: Appropriate mentation CHEM -Hypoglycemia 63 -ro artifact vs true (hepatopathy vs infection vs other) -Elevated SDMA 39 (decrease from 44 on 6/8) -Elevated creatinine 3.0 (decrease from 3.7 on 6/8) -Elevated BUN 81 (decrease from 99 on 6/8) -Elevated phosphorus 8.2 (increase from 7.7 on 6/8) -Elevated sodium 141 (decrease from 167 on 6/8) -Hyperglobulinemia 4.7 (vs normal 5.3 on 6/8) -Mild ALP elevation 222 (slight increase from 214 on 6/8) A: Severe azotemia, improving - ro AKI (toxin vs infection vs inflammatory vs other) vs acute on chronic vs other Hyperphosphatemia - sl worse today Hypernatremia - improving Hyperglobulinemia Mild ALP elevation Demodicosis, dermatitis, pododermatitis Underweight with muscle wasting Hx vomiting - resolved P: Replace IV catheter and start LRS at 2x maintenance (~100 ml/hr) today *Disconnect and d/c overnight, reassess tomorrow Continue cefpodoxime and gabapentin Seek placement for continued vet care - Snickers will need bloodwork rechecks and continued supportive care. Ideally he would also have an AUS to evaluation his kidneys for any permanent damage/abnormalities. CTM closely while at QACC

6/10/2026

Addendum 1:40pm - patient ripped out IV catheter. Not the first time this has happened, return to SQ LRS - give 750 ml SID and recheck as scheduled.

6/11/2026

Recheck severe azotemia, demodicosis, etc S/O: QAR, great appetite, no c/s/v/d noted pink moist mm, CRT <2s EENT: Mild white/gray mucoid discharge OU, no nasal discharge ORAL: mm pink and moist, CRT <2; mod tartar visible LUNGS: Eupneic MSI: Diffuse dermatitis/alopecia as previously noted - stable CNS: Appropriate mentation A: Severe azotemia, improving - ro AKI (toxin vs infection vs inflammatory vs other) vs acute on chronic vs other Hyperphosphatemia - sl worse today Hypernatremia - improving Hyperglobulinemia Mild ALP elevation Demodicosis, dermatitis, pododermatitis Underweight with muscle wasting Hx vomiting - resolved P: CWCP, DVM recheck 6/12 Seek placement for continued vet care - Snickers will need bloodwork rechecks and continued supportive care. Ideally he would also have an AUS to evaluation his kidneys for any permanent structural abnormalities. CTM closely while at QACC **WILL EAT MEDS IN KITTEN FOOD** Consider repeat chemistry 6/13, sooner if P clinically worsening

Upon intake he allowed all handling by staff. Counselors were able to place ACC collar and scan for M/C