10/30/2024

DVM Intake Exam Estimated age: 8-9y Microchip noted on Intake? scanned negative History: Stray brought in by police Subjective: BAR Observed Behavior - Tense but allows placement of muzzle and all handling for exam and tasks. Evidence of Cruelty seen -no Evidence of Neglect seen-no Evidence of Trauma seen -no Objective T = P =wnl R =wnl BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: muzzle in place, not examined PLN: No enlargements noted H/L: NR, grade 2/6 murmur detected, CRT < 2, Lungs clear, eupneic ABD: Non painful, firm palpation of cranial abdomen, but reported just ate large amount of food U/G: male intact, 2 scrotal testes MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: normal external Wood's Lamp Exam: not performed Assessment underweight heart murmur Prognosis: good Plan: intake tasks new home re-palpate abdomen if any concerns cbc/chem/T4 to lab TID feeding SURGERY: Permanent waiver due to age and heart murmur

11/5/2024

HCT 38.2% low end of normal Chem WNL T4 1.6 ug/dl wnl A: Not remarkable P: Monitor

11/8/2024

SO: Reported vomiting bile repeatedly this morning. Had previously had no concerns reported. On intake had firm palpation of cranial abdomen, but had recently eaten large portion of food. QAR, allows all handling with soft body. W: 42.5 lbs (loss) T: 101.1 eent: eyes clear, no ocular or nasal dc apparent h/l: eupneic, no coughing or sneezing appreciated abd: abd palp cranial abdomen soft, but mobile palpable mass mid ventral abdomen approximately kidney size msi: ambulatory x4 neuro: mentation alert and appropriate A: vomiting-r/o FB v mass v other P: AFAST of abdomen, soft tissue opacity appears to be within lumen of intestines Sedated for radiographs to confirm 0.4ml dexmedetomidine 500mcg/ml and 0.4ml butorphanol 10mg/ml IM Three view abdominal radiographs soft tissue opacity FB visible in all three views Recommending abdominal explore

11/8/2024

Exploratory laparotomy 1.9ml cerenia IV 0.25ml methadone 10mg/ml IV 12ml unasyn slow IV preoperatively Cephalic catheter placed and anesthesia induced with propofol to effect Entotracheal tube introduced and maintained on iso and oxygen (see anesthesia sheet) Midline incision with skin incision deviating to left of prepuce Small intestine exteriorized and cylindrical firm foreign body identified in ileum at ileocolic junction Area packed off with sterile gauze and intestines covered with damp cloth attempted to move FB orally, but unable incised over object until object able to be removed with light traction. Incision closed using 3-0 monocryl in single layer simple continuous fashion. Incision lavaged with saline and checked for deficits Placed omental wrap ran and replaced intestines again ileus and congestion noted throughout ileum, jejunum and duodenum appear normal without distention intestines replaced and abdomen flushed midline closed with 2-0 PDS in simple continuous pattern SC tissue closed with 2-0 PDS in simple continuous pattern skin closed using 2-0 monocryl in intradermal pattern Dog Neuter Was this dog a cryptorchid? no If so describe -n/a Pre scrotal Incision Spermatic Cord Ligation with: 2-0 monocryl 1x miller's 1x transfixing Sub Q closure: 2-0 monocryl simple continuous Skin closure: 2-0 monocryl intradermal and small amount of tissue glue Green Linear Tattoo Placed near Midline Surgeon: 1697 Additional Note: Slow recovery 0.1ml antisedan IM On waking drooling and nauseous starting metoclopramide 5mg/ml 1.1ml IV BID x2d continue buprenorphine 0.3mg/ml 1.2ml IV BID x2d

11/8/2024

Neuter and Exploratory laparotomy performed by Vet: 1697 Patient anesthesia form uploaded to Shelter Buddy in Vet Documents.

11/8/2024

CBC/chem in house CBC HCT 30.5% WBC 24.70 K/uL neutrophila and monocytosis Chem BUN 6mg/dL Cl 105 mmol/L A: blood work compatible with decreased nutrient intake and vomiting. Continue with current treatment plan

11/9/2024

SO: Yesterday enterotomy performed to remove corncob FB from ileocolic junction BAR, abdomen a little tucked when walking, but otherwise appears comfortable. Did not eat canned food overnight eent: eyes clear, no ocular or nasal dc apparent h/l: eupneic, no coughing or sneezing appreciated msi: ambulatory x4, surgical incisions CDI neuro: mentation alert and appropriate A: post op enterotomy and neuter P: Continue pain management and IV antibiotics and anti emetics Ate canned chicken with good appetite will try to continue small meals through day

11/9/2024

Did not eat again today despite tempting with multiple treat foods. No vomiting, passed some semi formed feces BAR, allows all handling T: 102.7 F yellow seromucoid nasal dc apparent abd soft A: post op neuter and enterotomy early CIRDC P: possible early CIRDC complicating recovery brief AFAST no obvious free fluid noted Changing antibiotics to enrofloxacin 100mg/ml 1.9ml diluted to 20ml slow IV SID x3d last metoclopramide was administered this morning

11/10/2024

Issue List: - post-op FB surgery - anorexia - heart murmur - coughing QAR H pink 1 sec EENT: no nasal or ocular discharge noted H/L: eupneic; no crackles and wheezes; h/o heart murmur PLN: WNL ABD: relaxed U/G: MC MSI: Ambulatory x 4, dull hair coat with focal areas of alopecia CNS: Mentation quiet - no signs of neurologic abnormalities A) post-op FB surgery anorexia coughing r/o pneumonia vs cardiac vs other P) Sedate with propofol- 6 ml titrated Chest Rads: right sided middle lung lobe- alveolar pattern r/o pneumonia secondary to CIRDC vs aspiration vs other

11/11/2024

Pet standing in kennel. He did not eat o/n or this morning. Temp: 102.3 RR: 32 EEN: Green liquid discharge dripping from nose. No ocular discharge ORAL: MM pale pink crt < 2 sec CV: Grade 2/6 murmur. RESP: Hacking cough after walk. Quiet lungs. Mildly increased RE. Tachypneic. MSI: Ventral midline incision CDI. Ambul x 4 BCS 3/9 Generalized muscle wasting. NEURO: QAR A: Anorexia Pneumonia 3 day post op enterotomy Underweight Anemic Heart murmur Prognosis: Guarded Plan LRS 50 mls IV c/w enrofloxacin Nebulize SID

11/12/2024

Pet curled up in bed. He did not eat o/n. RR 40 after walk EENO: MM pink moist crt < 2 seconds Less green liquid discharge dripping from nose today. RESP: Lungs quiet RR elevated but RE WNL Abd/UG: Soft, pliable. MSI: Ambul x 4. Ventral abdominal incision CDI. NEURO: QAR AFAST: No free fluid in abdomen. A: Pet is brighter than yesterday and hops in and out of kennel. Hydration and perfusion are better. Anorexia persists Tachypnea persists r/o pneumonia +/- enteritis/pancreatitis Prognosis: Poor Plan LRS 500 mls SQ sid x 2 days Syringe feed 1 can of Purina CN twice a day Gabapentin 300mg 1 capsule po bid x 5d c/w Enrofloxacin SQ

11/12/2024

Sleeping RR 40

11/13/2024

PROGRESS EXAM- pneumonia + 5 days post enterotomy for FB S/O: Quiet, dull in kennel. Tachypneic with increased effort. Harsh lung sounds bilaterally throughout fields. No ocular or nasal discharge present today. Moist mm. Turned nose away and lip smacked multiple times when offered food. T 102.6 P 110 bpm R 48 bpm Spot BG: 75 g/dL A: Anorexic Tachypneic Dull, lethargic P: Repeat bloods - CBC/Chem in house, last bloods carried out on 11/8 Keep in medical on supportive care and medical feeding *Extend course of enrofloxacin SQ for another 5 days *Extend LRS 500ml SQ fluids q24h x 3 days *Start Entyce (30mg/ml) 1.9ml PO q24h x 3 days *Continue Cerenia 1.9ml SQ q24h x 3 days *Recheck tomorrow 11/14, extend or discontinue meds as needed *Seek placement - requires more intensive care than what can be provided in shelter. *Consider setting deadline for placement during next check tomorrow

11/14/2024

Hx: post-op GI foreign body (corn cob) and enterotomy, pneumonia/cirdc, anorexia S: QAR, coughing repeatedly, ate CN wet well o/n, eats well this morning if left alone to eat O: Pulse ox (on ear): 92% EEN- eyes clear, green nasal discharge H/L- Coughing repeatedly, tachypneic (RR: 30 bpm) MSK/i- Ambulatory x4, underweight Neuro- alert/appropriate A: Eating CN wet CIRDC/pneumonia Recovering well post op Underweight P: Switch to oral enrofloxacin to finish out course Adding on Clindamycin 225mg (~11mg/kg) PO BID x10d Continue with fluids/cerenia/entyce Monitor closely

11/15/2024

Quiet. Ate well o/n, thick yellow nasal discharge, diarrhea in kennel. P: CWCT +/- add on Fortiflora

11/19/2024

Issue List: - post-op FB surgery - h/o anorexia; eating well - h/o heart murmur (not appreciated on presentation) - coughing but less frequently QAR H pink 1 sec EENT: no nasal or ocular discharge noted H/L: eupneic; no crackles and wheezes; h/o heart murmur (not appreciated) PLN: WNL ABD: relaxed U/G: MC MSI: Ambulatory x 4, dull hair coat with focal areas of alopecia CNS: Mentation quiet - no signs of neurologic abnormalities A) post-op FB surgery coughing r/o pneumonia; seems to be improving P) CWSC homing/placing