1/10/2020

DVM Intake Exam Estimated age: 9-10 years Microchip noted on Intake? yes History: OS, has been vomiting and peeing outside of the litter box. O believed pet was blocked and he was taken to RDVM where a blockage was ruled out. O did not present with medical records, is currently on C/D Subjective: BARH, no c/s/v/d. O report urinating outside of the litter box. Observed Behavior - Initially very sweet and affectionate, walked out of kennel and was seeking attention/head butting. Escalated very quickly during handling and intake tasks. Evidence of Cruelty seen - No Evidence of Trauma seen - No Objective P = WNL R = WNL BCS = 6/9 EENT: No ocular/nasal discharge. Ears clear of debris/cerumen. Oral Exam: adult dentition, moderate to severe dental plaque/tartar, moderate gingival inflammation. MM pink, moist, CRT <2s. PLN: No enlargements noted H/L: No murmurs or arrythmias ausculted. Normal BV sounds, no crackles or wheezes. ABD: Soft, non painful, no masses palpated U/G: MN, small bladder noted, no discharge MSI: Ambulatory x 4, skin free of parasites, no masses noted, slightly dry hair coat, moderate muscle wasting noted CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: not performed, externally normal Assessment: Inappropriate elimination (per O) Stage III-IV dental disease Prognosis: Fair pending elimination Plan: CTM while at BACC Monitor litter box usage sign C/D diet only Monitor closely on daily rounds SURGERY: Already neutered

1/11/2020

Small amount of urine in box this morning. Eating well. BAR

1/12/2020

Progress exam History: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease Today, 1/12: Monitoring litterbox usage. Subjective: BAR, no coughing/sneezing/vomiting/diarrhea. Normal urine and feces in litterbox. Objective: Cageside exam performed. Eyes: Clear bilaterally, no discharge Nasal Cavity: No nasal discharge. Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Integument: Unremarkable haircoat. Neuro: Appropriate mentation. Assessment: -Inappropriate elimination (none seen) -Stage III/VI dental disease Prognosis: Good Plan: -C/D diet only -CTM while at BACC

1/13/2020

Normal litterbox usage recorded, normal urine in litterbox. CTM closely while at BACC.

1/19/2020

Progress Exam History: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen Today, 1/19: URI signs seen on rounds. Subjective: BAR, no vomiting/diarrhea. Sneezing Objective: Cageside exam performed. Eyes: Clear bilaterally, no discharge Nasal Cavity: Mild nasal discharge Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Integument: Unremarkable haircoat. Neuro: Appropriate mentation. Assessment: -Mild URI -Stage III/VI dental disease Prognosis: Good Plan: -Start doxycycline 10 mg/kg PO q24h x 10d until 1/28 -Recheck day 7 -Move to isolation tomorrow if no foster found -C/D diet only

1/21/2020

No placement found, moved to ISO

1/25/2020

Progress Exam History: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline S: BAR. No csvd. Eating well Eyes: Grossly appropriate OU. Ears: Unremarkable AU. Nasal Cavity: No nasal discharge. Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Neuro: Appropriate mentation. Assessment: URI- no signs noted Stage III/VI dental disease Prognosis: Good Plan: Ok to move out of iso and finish medications C/D diet only

1/26/2020

Progress exam History: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline 1/25: URI resolved Today, 1/26: ACS noted inappropriate elimination, straining in litterbox. Subjective: BARH, no coughing/sneezing/vomiting/diarrhea. Does not eat C/D wet food but has good appetite. Objective: P: WNL 210 bpm R: WNL BCS: 4/9 OP: Mucous membranes pink and moist. EENT: Eyes, ears, and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful CV: No murmurs or arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Soft, nonpainful, no palpable masses. Bladder moderate size, soft and non-painful UG: male neutered, no discharge INT: Good hair coat, no areas of alopecia or pruritus, no ectoparasites or masses noted. Urine noted on coat. MS: Ambulatory x4, no pain on palpation of epaxials NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. CBC: All values WNL Chemistry: Mild hyperglobulinemia 5.4 (2.8-5.1 g/dL) T4: WNL 1.8 (0.8-4.7 ug/dL) Assessment: -Inappropriate elimination (r/o FLUTD vs UTI vs urolithiasis -Stage III/VI dental disease Prognosis: Fair Plan: -CBC/Chemistry/T4 -Urinalysis (send out to lab) -Start gabapentin 20 mg/kg PO q12h indefinitely -Start prazosin 0.5 mg PO q12h x 7d until 2/1 -Start simbadol 0.12 mg/kg SQ q24h x 5d until 1/30 -Monitor litterbox usage closely

1/27/2020

Hx: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline 1/25: URI resolved 1/26: ACS noted inappropriate elimination, straining in litterbox. Started on gabapentin, prazosin, and simbadol. CBC/Chem CBC: All values WNL Chemistry: Mild hyperglobulinemia 5.4 (2.8-5.1 g/dL) T4: WNL 1.8 (0.8-4.7 ug/dL) Today, 1/27- Progress exam SO: BARH, no c/s/v/d. E/d well. Small amount of dry c/d donated and he immediately started eating it. Will lean into pets and seek attention. Allows all handling. Normal amount of urine noted in litter box, no little droplets noted. EENT: No ocular/nasal discharge. Ears clear of debris/cerumen. Oral Exam: adult dentition, moderate to severe dental plaque/tartar, moderate gingival inflammation. MM pink, moist, CRT <2s. PLN: No enlargements noted H/L: No murmurs or arrythmias ausculted. Normal BV sounds, no crackles or wheezes. ABD: Soft, non painful, no masses palpated U/G: MN, small bladder noted, no discharge MSI: Ambulatory x 4, skin free of parasites, no masses noted, slightly dry hair coat, moderate muscle wasting noted CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: not performed, externally normal A: Inappropriate elimination r/o FLUTD vs UTI vs urolithiasis Stage III/VI dental disease Prog: Fair P: CTM while at BACC Seek rescue placement Urinalysis (sent out to lab 1/26) Continue gabapentin 20 mg/kg PO q12h indefinitely Continue prazosin 0.5 mg PO q12h x 7d until 2/1 Continue simbadol 0.12 mg/kg SQ q24h x 5d until 1/30 Feed dry c/d until available Monitor litterbox usage closely on daily rounds

1/28/2020

UA (cysto): -USG 1.036 -pH 6.5 -Blood, RBCs present (likely secondary to cysto) -Protein 2+ (ro blood vs true proteinuria) -Occasional struvite cystals (ro artifact) Asessment: FLUTD with no evident primary underlying medical cause (ro stress vs mild crystalluria vs other)

1/30/2020

Hx: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline 1/25: URI resolved 1/26: ACS noted inappropriate elimination, straining in litterbox. Started on gabapentin, prazosin, and simbadol. CBC/Chem CBC: All values WNL Chemistry: Mild hyperglobulinemia 5.4 (2.8-5.1 g/dL) T4: WNL 1.8 (0.8-4.7 ug/dL) S: BARH. No csvd. Eating well. Small amount of urine noted in box. Eyes: Grossly appropriate OU. Ears: Unremarkable AU. Nasal Cavity: No nasal discharge. Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Integument: Otherwise unremarkable haircoat. Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. Assessment: Inappropriate elimination r/o FLUTD vs UTI vs urolithiasis Stage III/VI dental disease Prognosis: Fair P: CTM while at BACC Seek rescue placement Continue gabapentin 20 mg/kg PO q12h indefinitely Continue prazosin 0.5 mg PO q12h x 7d until 2/1 Feed dry c/d until available Monitor litterbox usage closely on daily rounds

1/31/2020

Vet Notes: 2:09 PM Hx: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline 1/25: URI resolved 1/26: ACS noted inappropriate elimination, straining in litterbox. Started on gabapentin, prazosin, and simbadol. CBC/Chem CBC: All values WNL Chemistry: Mild hyperglobulinemia 5.4 (2.8-5.1 g/dL) T4: WNL 1.8 (0.8-4.7 ug/dL) 1/30- reassess: urinated a small amount 1/31- on rounds, noted to be more quiet but still eating S: BARH. No csvd. Eating well. No urine noted in box, ACS notes box has been disturbed with no production in last few days S: BAR, normal hydration Eyes: Grossly appropriate OU. Ears: Unremarkable AU. Nasal Cavity: No nasal discharge. Heart: No murmurs or arrhythmias. Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Soft, non-painful. U/G: MN. No discharge. Bladder large, firm and unexpressable on palpation Musculoskeletal: Ambulatory x 4 with no appreciable lameness. BCS = 5/9 Integument: Otherwise unremarkable haircoat. Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. CBC: wnl Chem: wnl (though creatinine at high end at 1.7) Assessment: FLUTD with urinary obstruction Hx Inappropriate elimination Stage III/VI dental disease Prognosis: Fair P: Sedated with Butorphanol 0.4 mg/kg IM + Midazolam 0.4 mg/kg IM for IVC placement, then induced with propofol. Maintained on isoflourane throughout procedure Unblocking procedure: a 3.5Fr was placed into the urethra with mild resistance at the most distal tip of the urethra. ~140mls of dark yellow urine pulled from bladder Flushed bladder with multiple rounds of sterile saline until urine clear One lateral radiograph confirmed placement of U-cath, though tip ends around trigone Recovered uneventfully Start IVF @ 25mls/hr Empty bag and check UOP q12hr Continue gabapentin 20 mg/kg PO q12h indefinitely Continue prazosin 0.5 mg PO q12h x 7d until 2/7 Restart simbadol 0.24 mg/kg SQ SID x7d Feed dry c/d until available Monitor litterbox usage closely on daily rounds Seek NH placement ASAP- while U-cath is still in place, will need to go somewhere with 24hr fluids/monitoring, should leave shelter ASAP as stress with potentially instigate another episode **ADDENDUM***: upon waking up, patient ripped out both U-cath and IVC. Elected to give LRS 100ml SQ and monitor in medical at this time

2/1/2020

Hx: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline 1/25: URI resolved 1/26: ACS noted inappropriate elimination, straining in litterbox. Started on gabapentin, prazosin, and simbadol. CBC/Chem 1/27: no urine noted for 3 da CBC: All values WNL Chemistry: Mild hyperglobulinemia 5.4 (2.8-5.1 g/dL) T4: WNL 1.8 (0.8-4.7 ug/dL) 1/30- reassess: urinated a small amount 1/31- No urination noted in 3 days, large firm bladder. Passed U-cath and flushed bladder. Upon recovery, ripped U-cath out. Started on SQF, continued prazosin, simbadol, gabapentin S: BARH. No csvd. Eating well. No urine noted in box. Laying comfortably in cage- not noted to be straining or licking prepuce Eyes: Grossly appropriate OU. Ears: Unremarkable AU. Nasal Cavity: No nasal discharge. Heart: No murmurs or arrhythmias. Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. U/G: MN. No discharge. Bladder small to medium in size, soft on palpation Musculoskeletal: Ambulatory x 4 with no appreciable lameness. BCS = 5/9 Integument: Otherwise unremarkable haircoat. Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. Assessment: FLUTD with urinary obstruction Hx Inappropriate elimination Stage III/VI dental disease Prognosis: Fair P: Continue gabapentin 20 mg/kg PO q12h indefinitely Continue prazosin 1mg PO q24hr until 2/7--only have capsules available, no tablets Continue simbadol 0.24 mg/kg SQ SID until 2/7 Continue LRS 100 mls SQ SID until 2/3 Offer both wet and dry food Monitor litterbox usage closely Seek NH placement ASAP- high chance of reblocking given stressful environment

2/2/2020

Progress exam History: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline 1/25: URI resolved 1/26: ACS noted inappropriate elimination, straining in litterbox. Started on gabapentin, prazosin, and simbadol. CBC/Chem 1/27: no urine noted for 3 da CBC: All values WNL Chemistry: Mild hyperglobulinemia 5.4 (2.8-5.1 g/dL) T4: WNL 1.8 (0.8-4.7 ug/dL) 1/30- reassess: urinated a small amount 1/31- No urination noted in 3 days, large firm bladder. Passed U-cath and flushed bladder. Upon recovery, ripped U-cath out. Started on SQF, continued prazosin, simbadol, gabapentin Today, 2/2: Progress exam Subjective: BARH, no coughing/sneezing/vomiting/diarrhea. Eating and drinking well. No urine in box, actively straining for several minutes in litterbox with no production. Objective: P: 150 bpm (taken while under sedation) R: WNL BCS: 7/9 OP: Mucous membranes pink and moist. CRT <2. EENT: Eyes, ears, and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful CV: No murmurs or arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Urinary bladder moderately distended and painful on palpation. Otherwise unremarkable, no other masses. UG: male castrated, no discharge INT: Good hair coat, no areas of alopecia or pruritus, no ectoparasites or masses noted. MS: Ambulatory x4, no pain on palpation of epaxials NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Urinary catheter placement: Sedated with Butorphanol 0.4 mg/kg IM + Midazolam 0.4 mg/kg IM for IVC placement, then induced with propofol. Maintained on isoflourane throughout procedure Unblocking procedure: a 5 Fr red rubber catheter was placed into the urethra with mild resistance midway through the urethra. Passed easily with flushing with sterile saline. ~120mls of dark yellow urine pulled from bladder, no hemorrhage noted. Flushed bladder with multiple rounds of sterile saline until urine clear. The red rubber catheter was pulled, and a 3.5 Fr slippery sam catheter was then placed with no resistance. One lateral radiograph confirmed placement of U-cath. The slippery sam cathter was then sutured in place with 4 simple interrupted sutures (2-0 PDS) and a collection system was attached. Recovered uneventfully. CBC: No significant abnormalities Chemistry: All values WNL T4: WNL 2 (0.8-4.7 ug/dL) Assessment: -FLUTD with urinary obstruction -Hx inappropriate elimination -Stage III/VI dental disease Prognosis: Fair to guarded Plan: -CBC/Chemistry -Unblock and place indwelling urinary catheter -Restart IVF @ 24mls/hr -Empty bag and check UOP q12hr -Continue gabapentin 20 mg/kg PO q12h indefinitely -Extend prazosin 0.5 mg PO q12h x 7d until 2/9 -Extend simbadol 0.24 mg/kg SQ SID x7d until 2/9 -Start onsior 2 mg/kg SQ q24h x 3d--patient is extremely uncomfortable and continues to try to remove urinary catheter. Monitor kidney values closely, repeat chemistry 2/4 -Feed dry c/d while available -Seek NH placement ASAP- while U-cath is still in place, will need to go somewhere with 24hr fluids/monitoring, should leave shelter ASAP as stress with potentially instigate another episode

2/3/2020

Progress exam History: Intake 1/10/19: Owner surrender, reported inappropriate elimination. Noted stage III/IV dental disease 1/12: No inappropriate elimination seen 1/19: URI signs seen on rounds- started on doxycycline 1/25: URI resolved 1/26: ACS noted inappropriate elimination, straining in litterbox. Started on gabapentin, prazosin, and simbadol. CBC/Chem 1/27: no urine noted for 3 days CBC: All values WNL Chemistry: Mild hyperglobulinemia 5.4 (2.8-5.1 g/dL) T4: WNL 1.8 (0.8-4.7 ug/dL) 1/30- reassess: urinated a small amount 1/31- No urination noted in 3 days, large firm bladder. Passed U-cath and flushed bladder. Upon recovery, ripped U-cath out. Started on SQF, continued prazosin, simbadol, gabapentin 2/2: Straining noted again, replaced urinary catheter and started IVF, onsior. Repeated CBC/Chemistry. CBC: No significant abnormalities Chemistry: All values WNL T4: WNL 2 (0.8-4.7 ug/dL) Today, 2/3: Progress exam Subjective: BARH, no coughing/sneezing/vomiting/diarrhea. Eating and drinking well, normal urine in collection system. Objective: P: WNL R: WNL BCS: 7/9 OP: Mucous membranes pink and moist. CRT <2. EENT: Eyes, ears, and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful CV: No murmurs or arrhythmias RESP: Eupneic, no crackles/wheezes UG: male castrated, no discharge. Collection system in place. INT: Good hair coat, no areas of alopecia or pruritus, no ectoparasites or masses noted. MS: Ambulatory x4, no pain on palpation of epaxials NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Urine output: ~400ml produced over 13.5 hours, roughly 30 ml/hr = ~5 ml/kg/hr urinary losses Assessment: -FLUTD with urinary obstruction -Hx inappropriate elimination -Stage III/VI dental disease -Post-obstructive diuresis Prognosis: Fair to guarded Plan: -CBC/Chemistry -Increase IVF to 30mls/hr (5 ml/kg/hr) -Empty bag and check UOP q12hr -Continue gabapentin 20 mg/kg PO q12h indefinitely -Continue prazosin 0.5 mg PO q12h x 7d until 2/9 -Continue simbadol 0.24 mg/kg SQ SID x7d until 2/9 -Continue onsior 2 mg/kg SQ q24h x 3d -Monitor kidney values closely, repeat chemistry 2/4 -Feed dry c/d while available -Seek NH placement ASAP- while U-cath is still in place, will need to go somewhere with 24hr fluids/monitoring, should leave shelter ASAP as stress with potentially instigate another episode

Upon intake, Solomon was vocal. He was friendly and allowed all handling.