9/10/2018

DVM Intake Exam Estimated age: ~12-14 years Microchip noted on Intake? negative History : stray Subjective: QARH. No csvd. Runs into front of kennel-suspect blind. Observed Behavior - very sweet. Easily handleable. Did well for all medical handling and procedures. Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = eupneic BCS 6/9 EENT: Eyes have thick mucoid d/c with hyperpigmentation and corneal scarring, ears clean, no nasal discharge noted Oral Exam: adult dentition with mild dental tartar, no oral lesions noted PLN: No enlargements noted H/L: NSR, Grade 1/6 HM, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated, unable to deeply palpate due to distension U/G: MN MSI: Ambulatory x 4, skin free of parasites, ~3cm soft tissue mass on RFL, ~1cm pink friable soft tissue mass on LHL, skin has diffuse thinning of hair with comedomes, thick scabs on dorsum, severe erythema and pyoderma on ventrum with plaques, papules, and pustules CNS: mentation appropriate - no signs of neurologic abnormalities Assessment: Geriatric suspect underlying Grade 1/6 HM KCS Severe skin disease/pyoderma suspect secondary to endocrine disorder vs allergies vs neoplasia vs other Plan: Continue to monitor while at BACC STT-0 OU Fluorescein stain-negative OU Start optimmune OU BID until ophthalmology consult Start erythromycin OU BID until ophthalmology consult Cleaned eyes Start simplicef 10mg/kg PO SID x7d until 9/17 Rec dermatology consult with mass removal and histopath Wood's Lamp negative Scheduled for medicated bath CBC-leukocytosis 25.69 (5.05-16.76) with neutrophilia 19/87 (2.95-11.64), monocytosis 2.14 (0.16-1.12) Chemnsf T4-wnl (2.1) Prognosis: Poor to guarded longterm SURGERY: neutered

9/14/2018

H:CIRDC signs seen on rounds S: QAR, hyperactive, consistent coughing, no sneezing, no vd. Eyes: Mucoid ocular discharge OU Ears: Unremarkable AU. Nasal Cavity: Mild serous nasal discharge Lungs: Eupneic U/G: Normal external genitalia. No discharge. Musculoskeletal: Ambulatory x 4 with no appreciable lameness. BCS = 5/9 Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. Assessment 1) CIRDC 2) Geriatric suspect underlying 3) Grade 1/6 HM 4) KCS 5) Severe skin disease/pyoderma suspect secondary to endocrine disorder vs allergies vs neoplasia vs other Plan: Move to iso, start Doxycycline 10 mg/kg SID x 14 days Start enrofloxacin 10 mg/kg PO SID x 14 days

9/14/2018

History : CIRDC signs noted on rounds, started on enrofloxacin and doxycycline today. Consistent cough and loud breathing noted by care staff since this morning. S/O: BAR, loud stertorous breathing, active, allows handling EENT: Eyes thick mucoid discharge and chronic corneal changes OU, no nasal discharge noted Oral Exam: mm pink H/L: Severe sterorous breathing, coughing, resp rate ~36, unable to auscult heart due to loud upper airway sounds but previously ausculted grade I heart murmur ABD: Tense, non painful, no masses palpated MSI: Ambulatory x 4, lesions/alopecia, dermal masses as described in previous exams, BCS 7/9 CNS: Mentation appropriate, no signs of neurologic abnormalities Assessment: Cough, stertor - ro CIRDC +/- pneumonia vs Collapsing trachea vs CHF vs other Previously diagnosed heart murmur Diffuse skin disease Overweight Geriatric - suspect chronic condition KCS Plan: TXR (Dexdom 0.2 ml IM and Butorphanol 0.3 mg/kg IV for sedation) Stertor and loud breathing significantly improved upon sedation

9/14/2018

TXR - severe collapsing trachea on lateral view, focal region of increased opacity/interstitial pattern in caudal right lung field on VD. A: Suspect collapsing trachea exacerbated by stress, CIRDC. P: Continue with doxy, enrofloxacin. Add cerenia 1.5 mg/kg PO SID x 5 days. Consider antitussive vs sedative if no improvement.

9/15/2018

History : Intake on 9/10. Noted to be geriactric, have KCS and pyoderma. CBC-leukocytosis 25.69 (5.05-16.76) with neutrophilia 19/87 (2.95-11.64), monocytosis 2.14 (0.16-1.12) Chemnsf T4-wnl (2.1) 9/14- Diagnosed with CIRDC, started on baytril and doxycycline. Coughing worsened and chest radiographs taken- TXR - severe collapsing trachea on lateral view, focal region of increased opacity/interstitial pattern in caudal right lung field on VD. S/O: QAR to BAR, Consistent harsh, honking cough. No svd. Noted to be eating. Eyes: Mucoid ocular discharge OU Ears: Unremarkable AU. Nasal Cavity: Mild serous nasal discharge Lungs: Severe stertor, Eupneic U/G: Normal external genitalia. No discharge. Musculoskeletal: Ambulatory x 4 with no appreciable lameness. BCS = 5/9 Integument: Otherwise unremarkable haircoat. Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. Assessment: 1) Coughing - ro CIRDC, though appears to be component of collapsing trachea based on chest radiographs. Higher risk for development of pneumonia 2) Geriatric suspect underlying 3) Grade 1/6 HM 4) KCS 5) Severe skin disease/pyoderma suspect secondary to endocrine disorder vs allergies vs neoplasia vs other Prognosis: guarded to poor Plan: Continue doxycycline 10 mg/kg PO SID until 9/28 Continue enrofloxacin 10 mg/kg PO SID until 9/28 Continue optimmune OU BID until ophthalmology consult Continue erythromycin OU BID until ophthalmology consult Continue simplicef 10mg/kg PO SID x7d until 9/17 Rec dermatology consult with mass removal and histopath Needs to leave ASAP- needs proper management and monitoring of collapsing trachea