8/31/2025

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.

8/31/2025

DVM Intake Exam Estimated age: >15 yrs Microchip noted on Intake? Negative History: Agency Subjective: Q-BAR H pale pink 2-3 sec Observed Behavior - Easily examined; body somewhat tense; shaking; readily eating Evidence of Cruelty seen - No Evidence of Trauma seen – No Evidence of Neglect- No Objective P = 120hr R = 40-45rr BCS 4/9 EENT: Eyes- NSOU, Blind OD, ears clean, slight ocular discharge noted Oral Exam: 4/4 dental issues PLN: No enlargements noted H/L: NSR, Grade 5/6 heart murmur, CRT 2-3 sec, pale-pale pink MM, Lungs sound congested, tachypneic and with increased abdominal component/respiratory effort ABD: Non painful, no masses palpated, moderate-severe distension consistent with ascites U/G: FI MSI: Ambulatory x 4, skin free of parasites, no masses noted, dull hair coat, significant generalized patchy alopecia, unspecified chronic dermatitis CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment Geriatric with suspect chronic conditions - suspect terminal Blind OD CHF, decompensated Unspecified dermatitis Alopecia Prognosis: Poor to guarded Plan: Intake procedures: Furosemide 0.18 ml IM @ 4 pm Pimobendan 1/2 of 2.5 mg (1.25 mg) PO @ 4 pm, then BID indefinitely Microchip Heartworm test Furosemide start 9/1 AM: 10 mg (1/2 of 20 mg) PO BID indefinitely Surgery: permanent waiver due to age *assessing for stabilization response and likely pending euthanasia* DNR

9/1/2025

dog resting comfortably still has increased abdominal effort when aroused no coughing Laxix- 0.18 ml SQ q 12-24 hrs (changing to injectable as pill form not available)

9/2/2025

Recheck CHF, geriatric dog S/O: QAR, empty med trays but did not eat food, no c/s/v/d noted. Eating baby food. EENT: No ocular or nasal discharge, OD buphthalmos, absent menace OU H/L: Grade 5 murmur, mild increased inspiratory effort MSI: Diffuse alopecia, pigmentation and lichenification consistent with chronic dermatitis CNS: Quiet mentation CBC: Hct 28.8 (L), WBC 30.80 (H), neutrophils 24.03 (H), monocytes 4.48 (H), platelets 965 (H) CHEM: creatinine 3.5 (H), BUN 121 (H), phosphorus >16.1 (H), chloride 107 (L) TT4: 0.9 (L) 2VCXR: cardiomegaly appreciated, no significant signs of CHF A: Azotemia - ro pre-renal vs renal vs post-renal Anemia Leukocytosis Heart murmur, cardiomegaly Suspected CHF - rad consult pending Geriatric Dermatitis, chronic - ro allergy Blind Buphthalmos OD Prognosis: poor long-term P: CBC/CHEM/T4 in house Chest rads - submitted for rad consult Furosemide 0.18 ml SQ given this AM Start medical feeding BID Monitor closely in ICU - consider EHR pending rad consult due to comorbidities and condition

9/2/2025

THORAX (September 2, 2025): Right lateral and ventrodorsal projections; 2 radiographs total. COMPARISON: None available. FINDINGS: • Cardiac silhouette: The cardiac silhouette is moderately enlarged resulting in increased apicobasilar length and a focal soft tissue bulge noted at the region of the left atrium. • Pulmonary vasculature: The pulmonary veins and arteries are symmetric and normal in size and shape. • Lungs: Diffusely throughout the lungs there is mild thickening surrounding the lower airways. On the ventrodorsal projection the right middle lung lobe is collapsed. On the ventrodorsal projection, the soft tissue opaque nodules noted superimposed over the right 10th intercostal space. • Mediastinum: The mediastinum is within normal limits of width and opacity, and the mediastinal structures are unremarkable. • Pleural space: The pleural space is normal. • Diaphragm: The diaphragmatic margins are smooth and well-defined. • Included abdomen: The stomach is moderately distended with heterogenous soft tissue opacity, consistent with postprandial changes. • Included musculoskeleton: The included musculoskeletal structures are unremarkable. CONCLUSIONS: 1. Moderate left-sided cardiomegaly without evidence of congestive heart failure, likely reflecting underlying degenerative mitral valve disease. 2. Mild diffuse bronchial pattern reflect age-related changes, however given the reported respiratory signs, lower airway disease of infectious, inflammatory or allergic etiologies warrant consideration. Additionally, the right middle lobar collapse may reflect atelectasis associated with positioning or bronchial plugging. Alternatively, lobar pneumonia remains possible. 3. The soft tissue opacity noted superimposed over the right caudal lung lobe likely reflects summation with a nipple. However, a true pulmonary lesion (e.g. granuloma, metastatic neoplasia) cannot entirely be excluded. RECOMMENDATIONS: A complete thoracic radiographic study (left and right lateral, plus ventrodorsal or dorsoventral projections) is generally recommended for most detailed evaluation of the thorax, given the variable aeration of the dependent lung lobes and potential loss of lesion distinction with surrounding atelectasis. As such, addition of left lateral projection to this study may be helpful for further evaluation. Additionally, ECG evaluation, blood pressure measurement, and a cardiologist consultation/echocardiography is recommended.

9/2/2025

Updated plan: Okay to seek placement for hospice/palliative care. Prognosis remains poor, but patient is BAR and eating, allows all handling. Recommend EHR if placement not found quickly, unable to manage in shelter.

9/3/2025

furosemide being decreased to q 24 hrs

9/3/2025

Recheck heart disease, possible CHF at intake, kidney disease, geriatric, etc S/O: BAR, allows all petting, only ate small amount of medical feeding, not as interested in food; no c/s/v/d noted EENT: No active ocular or nasal discharge LUNGS: Mild abdominal effort, normal resp rate; heart murmur unchanged MSI: Diffuse alopecia/thin fur with pigmentation and lichenification as previously noted A: Geriatric Cardiomyopathy, heart murmur Possible CHF at intake, not appreciated on rads - ro effectively treated with furosemide vs other cause of dyspnea vs other Azotemia - ro renal vs other Chronic dertitis Ocular changes, absent menace Hyporexia P: Continue furosemide SID, med feedings BID Monitor breathing and QOL closely Patient has comorbidities with guarded to poor prognosis.

9/4/2025

recheck, cardiac dz, possible CHF, renal disease, geriatric S/O QAR, noted to not be eating today, didn't take HVTs when offered, no c/s/v/d, some fecal staining to the bedding where pup was sitting EENT: no ocular or nasal dc HL: slight increased in abdominal resp effort when first approached, relaxed during exam, nRR, 5-6/6 HM MSI: amb x 4, diffuse alopecia as prior A. Suspected CHF vs cardiomyopathy (other) Azotemia Geriatric Dermatitis P. Given furosemide injectable 0.18mL SQ today Start entyce 3mg/kg PO SID x 3 days Seek placement- p needs to be seen by full service vet hospital, now not eating. Prognosis remains guarded to poor

Upon intake dog was tolerant yet fearful. Staff was easily able to scan for MC, collar, pick up and place in kennel with no complications.