2/16/2018

[Spay/Neuter Waiver - Medical Condition] Your newly adopted is currently temporarily waived from the spay/neuter requirements of the City of NY by the staff veterinarians due to conjunctivitis & being underweight. Follow up care at your regular veterinarian is recommended to ensure continued treatment. Your veterinarian will advise you if surgical sterilization is appropriate.

2/16/2018

[DVM Intake] DVM Intake Exam Estimated age: 1 1/2-2y Microchip noted on Intake?n Microchip Number (If Applicable):n History : stray Subjective: qar, lameness rf Observed Behavior - very quiet painful and swollen rf paw Evidence of Cruelty seen -n Evidence of Trauma seen -y - bite vs other Objective T = 104.5 P = 250 R = wnl BCS 3/9 EENT: conjunctivitis and purulent d/c os only, ears clean, no nasal or ocular discharge noted Oral Exam: good condition, based on lack of significant wear and tarter - 1 1/2-2 yr PLN: No enlargements noted H/L: tachycardic and occ'l gallop CRT < 2, Lungs clear, eupnic, mild dehydration ABD: Non painful, possible cranial organomegally vs recent meal left cranial, soft not firm U/G: fi (?) MSI: Ambulatory x 3, lame rf and swelling of paw w/ possible abscess on paw pad skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal:ne Assessment: 18-24 m fi abscess paw left fore vs other trauma conjunctivitis os only - viral vs other underweight <5% dehydrated Prognosis: excellent Plan: cbc/chem wb rads lat/vd 100 cc lrs sq convenia 0.2 cc sq simbodol 0.55 cc sq terramycin os bid SURGERY: Okay for surgery Temporary waiver due to Permanent waiver due to

2/16/2018

[DVM Intake] DVM Intake Exam Estimated age: 18-24m Microchip noted on Intake?y Microchip Number (If Applicable):y History : stray Subjective:qar Observed Behavior -qar, lame rf Evidence of Cruelty seen -n Evidence of Trauma seen -y Objective T =104.5 P = 250 R = wnl BCS 3/9 EENT: os purulent d/c and conjunctivitis, ears clean, no nasal or ocular discharge noted Oral Exam: based on condition 18-24m PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic, dehydrated ABD: Non painful, possible cranial organomegally U/G: fi (?) MSI: Ambulatory x 3, skin free of parasites, no masses noted, healthy hair coat, possible abscess pad, swelling left hindfoot CNS: Mentation appropriate - no signs of neurologic abnormalities: wnl Rectal:ne Assessment: conjunctivitis and d/c os - r/o viral lameness/swelling - r/o abscess vs other traum mild dehydration cranial organomegally - mass vs full stomach vs other Prognosis: excellent Plan: 100 cc lrs sq 0.2 convenia sq 0.25 simbodol sq cbc/chem - severe, non-regen anemia (15.6%) and leukocytosis w/ neutrophilia and suspected bands wb rads lat/vd - +/- fx left hind mt 3, proximal and soft tissue swelling, full stomach terramycin bid os sedate to examine wounds - healing paw pad abrasion digit 2 rf - very small amount of purulent material, removed debris from between toes, no other bite wounds noted tomorrow recheck temp/pc/ts - +/- doxy vs pred trial SURGERY: Temporary waiver due to

2/16/2018

severe, non-regenerative anemia -15.6% leukocytosis (22.4) - neutrophilia (16.8) w/ suspected bands chem - wnl (gluc 165) felv/fiv both negative

2/16/2018

X-RAY EVAL - 1) RF - soft tissue swelling, appears to be radiopaque debris caudal paw 2) LH - +/- proximal, non-displaced fx mt 3 3) food filled stomach w/ granular debris and stool

2/17/2018

ACR: Recheck temp, PCV/TS, +/- add oral meds S/O: Cat is QAR, seems more hydrated today. BCS 3/9. EENT - blepharospasm and epiphora OU; crusting of nasal planum. Healthy adult dentition; multiple oral ulcerations affecting mainly hard palate. Heart/lungs - slight gallop rhythm, otherwise wnl. Abdomen soft, non-painful. Amb x 4, but walks very gingerly. Skin/coat - appears unkempt. Seems interested in food, but only ate small amount of a/d when offered T - 103F P - 170 R - 40 PCV/TS 15/6.4 A: Non-regenerative anemia DDx: Infectious, Immune-mediated, Open P: Starting on Doxycycline 50mg/mL - 0.4mLs PO q24h x 4wks. Gave first dose around noon on 2/17/18. Continue Simbadol for pain. Recommend rescue placement and transfer to outside vet ASAP due to anemia and need for possible transfusion. PROGNOSIS: Poor-Fair

2/18/2018

Progress exam History : stray intake 2/16. Gave SQ LRS, convenia, terramycin, and simbadol. cbc/chem - severe, non-regen anemia (15.6%) and leukocytosis w/ neutrophilia and suspected bands wb rads lat/vd - +/- fx left hind mt 3, proximal and soft tissue swelling, full stomach 2/17-started doxycycline Subjective: QAR, ~6-7% dehydrated. Eating well. Feet are painful. Normal bm and u in litter box. Mildly ataxic. Objective T =102.3 P = wnl R = wnl BCS 3/9 EENT: mild serous d/c ou, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition, mild staining PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs have mild increase in BV sounds ABD: SNP, NMP U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 3, skin free of parasites, no masses noted, healthy hair coat, swelling of RFL, LFL, and LHL-painful on palpation CNS: Mentation appropriate - no signs of neurologic abnormalities: wnl Assessment: Conjunctivitis and d/c os - r/o viral Lameness/swelling RFL, LFL, LHL- r/o abscess vs other trauma Dehydration Harsh BV sounds Oral ulcers Prognosis: Good to fair Plan: Continue doxycycline until 3/17 Start 20ml/kg SQ LRS until 2/20 (first dose given) Continue simbadol until 2/22 Soak feet in dilute chlorhex SID x3d until 2/20 (first treatment done) Continue terramycin until 2/22

2/19/2018

Progress exam History : stray intake 2/16. Gave SQ LRS, convenia, terramycin, and simbadol. cbc/chem - severe, non-regen anemia (15.6%) and leukocytosis w/ neutrophilia and suspected bands wb rads lat/vd - +/- fx left hind mt 3, proximal and soft tissue swelling, full stomach 2/17-started doxycycline 2/18-started SQ LRS, foot soaks Subjective: QAR, ~5-6% dehydrated. Eating 1/3-social eater. Feet are painful and walks gingerly on them. Normal bm and u in litter box. No csvd. Objective P = wnl R = wnl BCS 3/9 EENT: no ocular d/c, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition, mild staining PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs have mild increase in BV sounds ABD: SNP, NMP U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4 but walks very gingerly and high steps, skin free of parasites, no masses noted, healthy hair coat, swelling of RF paw, LF paw, and LH paw-painful on palpation CNS: Mentation appropriate - no signs of neurologic abnormalities: wnl Assessment: Conjunctivitis and d/c os - r/o viral Lameness/swelling RF paw, LF paw, LH paw- r/o immune mediated vs plasma cell pododermatitis vs abscess vs other trauma Dehydration Harsh BV sounds Oral ulcers-not appreciated today Prognosis: Good to fair Plan: Continue doxycycline until 3/17 Continue 20ml/kg SQ LRS SID until 2/20 Continue simbadol until 2/22 Soak feet in dilute chlorhex SID until 2/20 Continue terramycin until 2/22 Start cerenia 1mg/kg SQ SID x2d until 2/20 Give one dose of mirtazapine 3.75mg PO Rec CXR when stable enough to sedate Rec IM consult +/- blood transfusion +/- steroids

2/20/2018

Progress exam History : stray intake 2/16. Gave SQ LRS, convenia, terramycin, and simbadol. cbc/chem - severe, non-regen anemia (15.6%) and leukocytosis w/ neutrophilia and suspected bands wb rads lat/vd - +/- fx left hind mt 3, proximal and soft tissue swelling, full stomach 2/17-started doxycycline 2/18-started SQ LRS, foot soaks 2/19-started cerenia, gave one dose of mirtazapine Subjective: BAR, ~5-6% dehydrated. No csv but had one pile of D in litter box. Normal U in box. Eating voraciously-wet and dry. Stable but would benefit from hospitalization. Objective P = wnl R = wnl BCS 2-3/9 EENT: no ocular d/c, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition, mild staining, pale pink mm PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs have mild increase in BV sounds ABD: SNP, NMP U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4 but walks very gingerly, skin free of parasites, no masses noted, healthy hair coat, swelling of RF paw, LF paw, and LH paw-painful on palpation but improved CNS: Mentation appropriate - no signs of neurologic abnormalities: wnl Assessment: Conjunctivitis and d/c os - r/o viral-improved Lameness/swelling RF paw, LF paw, LH paw- r/o immune mediated vs plasma cell pododermatitis vs abscess vs other trauma-improved Dehydration Harsh BV sounds Oral ulcers-not appreciated today Prognosis: Good to fair Plan: Continue doxycycline until 3/17 Last day of dilute chlorhex and cerenia Extend LRS SQ 20ml/kg SID x3d until 2/23 Continue simbadol until 2/22 Continue terramycin until 2/22 Start metronidazole 15mg/kg PO BID x5d until 2/25 Recheck PCV/TS tomorrow Rec CXR when stable enough to sedate Rec IM consult +/- blood transfusion +/- steroids