9/15/2023

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.

9/15/2023

DVM Intake Estimated age: 10 years Microchip noted on Intake? No History: Owner surrender Subjective: BARH, no coughing/sneezing/vomiting/diarrhea Observed behavior: Panting, hyperactive, jumping as much as possible. Treat motivated, allows petting. Muzzled as a precaution for hip exam and intake tasks Evidence of cruelty seen: No Evidence of trauma seen: No Evidence of neglect seen: No Objective: P: WNL R: WNL BCS: 5/9 OP: Mucous membranes pink and moist. CRT <2. Stage III dental disease. EENT: Nuclear sclerosis OU, 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. UG: male intact, two descended testicles, no discharge INT: Good hair coat, no areas of alopecia or pruritus, no ectoparasites or masses noted. MS: Ambulatory x4 with marked ataxia and decreased ROM in hind limbs. Musculature at forelimbs markedly developed, mild-moderate muscle wasting of hind limbs. NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. CPs intact x4 Assessment: -Hip dysplasia -Senior pet -Stage III dental disease Prognosis: Good Plan: -Start gabapentin 15 mg/kg PO q12h indefinitely -Start amantadine 5 mg/kg PO q24h indefinitely -Scheduled bloodwork, start rimadyl if renal/liver values allow Surgery: Permanent waiver due to age

9/17/2023

NSF on CBC and Chemistry, liver and kidney values WNL. Okay to start Carprofen 4.4mg/kg PO SID. Monitor for inappetence/anorexia/vomiting/diarrhea.

9/21/2023

Reason for recheck: Patient reported by former owner to have hip dysplasia, but signs not consistent. Patient BAR with excellent appetite. Patient care staff report severe hind end ataxia- reported to fall to side after taking several steps and to have severe difficulty balancing when lifting hind leg to urinate. Sedated with butorphanol 0.2 mg/kg and dexdomitor 10 mcg/kg IV. After, reversed with antisedan 2v pelvic rads: NSF; femoral heads have appropriate acetabular coverage Survey rads of hind legs: NSF Brief sedated ortho exam- no palpable abnormalities, ROM of hips roughly WNL A: Ataxia- r/o geriatric vestibular disease vs. neoplasia vs. infection (previous distemper, parvo, otitis media/interna, other) vs. inflammation vs. structural/developmental vs. trauma vs. metabolic vs. toxic vs. other P: -Recommend placement ASAP with rescue group or adopter. Patient likely to have improved quality of life with environmental modifications in home such as avoiding slippery surfaces and using harness or sling. -Recommend follow-up with veterinarian with placement. Neurology consult +/- further diagnostics would be ideal. Patient may also benefit from physical therapy. -Recheck tomorrow. If not painful, consider discontinuing carprofen.

9/22/2023

Recheck ataxia S/O: BAR, very friendly - jumps out of kennel and falls immediately, wagging tail and allows all handling, mild cough, no s/v/d noted EENT: Mild serous nasal discharge noted, Eyes - nuclear opacities OU Oral: Moderate to heavy tartar visible, mm pink and moist Lungs: Eupneic, normal respiratory rate/effort ABD: SNP, NMP MSI: Ambulatory x 4 with marked ataxia in all limbs, falls over often, crossing over, stumbles/falls out of kennel; CPs intact - pulls paws away when attempting to place; falling to side; no notable pain elicited during ROM or spinal palpation CNS: Mentation appropriate A: Severe ataxia- r/o geriatric vestibular disease vs. neoplasia vs. infection (previous distemper, parvo, otitis media/interna, other) vs. inflammation vs. structural/developmental vs. trauma vs. metabolic vs. toxic vs. other CIRDC - mild Dental disease Senior-geriatric pet Nuclear sclerosis P: No treatment idicated for mild CIRDC signs, placed UTW sign Okay to discontinue pain medications, does not seem painful at this time Recommend emergency placement for neuro consult vs humane euthanasia due to QOL and inability to ambulate well

9/25/2023

Progress exam Subjective: BAR, mild cough. No s/v/d, appetite excellent, Sweet and affectionate old man, runs up immediately for pets and interaction Objective: Eyes: Nuclear sclerosis OU, no discharge Nasal Cavity: No nasal discharge noted today Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with marked ataxia--unchanged from previous exams, neurologic signs do not appear to be progressing Neuro: Appropriate mentation. Assessment: -Marked ataxia (r/o cervical stenosis vs IVDD vs previous trauma) -Mild CIRDC -Stage III dental disease Plan: -Restart gabapentin 15 mg/kg PO q12h indefinitely until cause of underlying ataxia can be definitively diagnosed -CTM while at BACC

10/3/2023

BAR in kennel, barking for attention. No noted coughing or sneezing, ataxia remains unchanged from previous exams with no progression. Assessment: -Marked ataxia (r/o cervical stenosis vs IVDD vs previous trauma) -Mild CIRDC (resolved) -Stage III dental disease Plan: -Continue gabapentin 15 mg/kg PO q12h indefinitely -CTM while at BACC

10/5/2023

Start trazodone 9 mg/kg PO q12 indefinitely for FAS (whining for attention in kennel, frequent panting).