3/21/2023

DVM Intake Exam Estimated age: 6-10 years based on dentition and general appearance Microchip noted on Intake? NO History: Owner surrender Subjective: Observed Behavior - QAR, hunched in back of den with dilated pupils. When removed from den, attempts to flee and hisses. Exam and tasks completed with gentle towel restraint. Evidence of Cruelty seen - NO Evidence of Trauma seen - NO Objective T = N/A P = 200 bpm R = 36 bpm BCS = 4/9 EENT: Mucoid ocular discharge OU, mild brown ceruminous discharge AU, mild nasal discharge/congestion Oral Exam: MM pink and tacky, all adult teeth with mild to moderate periodontal disease (2/4). Ulcerations visible on the tip of the tongue. PLN: No enlargements noted H/L: Grade 5/6 parasternal systolic heart murmur noted, no arrhythmias, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated; very firm feces palpated in colon U/G: Intact female, no spay scar or tattoo noted. No vaginal discharge. MSI: Ambulatory x 4, skin free of parasites, no masses noted, thinning hair coat on caudodorsal trunk CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally WNL Assessment Geriatric intact female - suspect underlying conditions Heart murmur - no clinical disease Suspect flea allergy with secondary hair loss URI with tongue ulceration Mild to moderate periodontal disease (2/4) Prognosis: Fair Plan: Intake tasks completed Awaiting behavioral assessment CBC/Chemistry/T4 submitted to IDEXX 75 mL LRS SQ 0.25 mL vitamin B12 SQ Recheck tomorrow SURGERY: Permanent waiver due to age and heart murmur

3/22/2023

History: 3/21: OS intake, moderate URI with tongue ulceration, grade V/VI HM, suspect flea allergy CBC: RBC 6.68 (L), Hct 27.9 (L), Hgb 9.4 (L), reticulocyte hemoglobin 15.1, basophils 0.211 (H), platelets 95 (L), platelet estimate adequate (clumps present), cholesterol 79 (L) Interpretation: NSF; extremely mild anemia may represent anemia of chronic disease QAR to BAR on top of feral den. Tolerated very brief exam, then hissed. Hunched posture, appears stressed. Did not eat yesterday or overnight. Offered variety- sniffed crunchy treats briefly but would not eat. EENT: Mild mucoid ocular discharge OU, no nasal or ocular discharge noted, no congestion noted today Oral Exam: Would not tolerate, omm pink and mildly tacky CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment URI with lingual ulceration Inappetence Prognosis: Fair Plan: Continue feeding variety Start LRS 10 ml/lb SQ q24 x 3 days Start Cerenia 1 mg/kg SQ q24 x 3 days Start Simbadol 0.12 mg/kg SQ q24 x 3 days Keep in medical and monitor closely on daily rounds, recheck tomorrow

3/23/2023

Check appetite: Patient QAR to BAR, hiding in back of feral den when approached. Mild serous ocular discharge. Very mild audible congestion. Did not eat overnight. Offered variety- no interest Plan: Start Mirataz to ear q24 x 3 days- first dose given Recheck tomorrow- consider starting Entyce if still not eating

3/24/2023

Recheck URI/anorexia S/O: QAR, not eating No c/s/v/d noted Moderate crusted dark nasal discharge No ocular discharge noted Normal resp rate and effort A: URI Anorexia Oral ulceration Heart murmur Dental disease Senior pet P: Continue SQ LRS, cerenia, simbadol, mirtazipine Start elura 2 mg/kg PO SID x 4 days Start medical feedings BID x 5 days Continue to monitor closely in medical

3/25/2023

Recheck appetite - QAR in den, not eating, gags when high value food placed near her, no c/s/v/d, scant nasal discharge. Continue with current treatment plan, consider e-tube placement if not eating in 48 hours.

3/27/2023

Recheck appetite Patient did not eat overnight. Offered chicken Temptations (favorite treat per previous O)- no interest, remained untouched hours later. QAR to BAR on top of den. Patient backs away when approached. Hissed, growled, and hypersalivated during treatments- staff only able to give treatments using shield in feral den. Plan: -Unable to manage feeding tube in-shelter due to patient's severe FAS and aversion to handling; suspect FAS (and perhaps appetite) would improve in less stressful environment -Continue medical feedings q12 until 3/29 -Extend LRS 75 ml SQ q24 until 3/29 -Extend Simbadol 0.12 mg/kg SQ q24 until 3/29 -Extend Cerenia 1 mg/kg SQ q24 until 3/29 -Extend Elura 2 mg/kg PO q24 until 3/29 -Extend mirataz topically to ear q24 until 3/29 -CTM in medical, recheck tomorrow

3/28/2023

Patient QAR to BAR. Possibly ate a Temptations Mixup Backyard Cookout treat- offered more, no interest. Plan: Continue with current treatment place Patient has placement- transfer out ASAP