9/6/2024

DVM Intake Exam Estimated age: 10y Microchip noted on Intake? scanned negative History: Brought to shelter by police after found tied outside. Subjective: BAR Observed Behavior - Subdued but allows all handling for exam. Seeking attention and pets throughout. Eating dog food offered. Evidence of Cruelty seen -no Evidence of Neglect seen-no Evidence of Trauma seen -no Objective T = P =wnl R =wnl BCS 4/9 EENT: Eyes OU moderate nuclear sclerosis, ears AS marked brown waxy dc, no nasal or ocular discharge noted Oral Exam: adult dentition with staining and moderate tartar, canines and incisors worn down. PLN: No enlargements noted H/L: NR, NMA, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: male intact, 2 smooth and symmetrical in scrotum MSI: Ambulatory x 4, skin free of parasites, multiple small firm skin masses on top of head, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: normal external Wood's Lamp Exam: not performed Assessment otitis externa AS skin masses dental disease Prognosis: fair Plan: intake tasks new home Starting EN diet proviable 1 capsule PO SID x10d monitor for further episodes of diarrhea SURGERY: Permanent waiver due to age

9/6/2024

[Spay/Neuter Waiver - Age] 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.

9/6/2024

Staff noted diarrhea + possible vomit in kennel. Pet is sleeping comfortably. A: Diarrhea- r/o stress colitis vs. other P: Parvo SNAP- negative Monitor

9/12/2024

SO: Reported having two episodes this morning. In am reported having vomiting with blood in vomit and then reported seeing blood in water bowl. BAR, wagging tail and taking all treats with good appetite. Allows all handling, but more tense around head eent: eyes clear, no ocular or nasal dc apparent oral: no obvious oral lesion on awake exam, mm pale h/l: eupneic, no coughing or sneezing appreciated, heart no murmur detected abd: soft and non painful, no obvious masses, bladder small and very firm, passed small amount of urine on palpation msi: ambulatory x4 neuro: mentation alert and appropriate A: anemia-mildly regenerative vomiting P: 2.8ml cerenia IV once CBC/chem in house CBC HCT 20.9% microcytic hypochromic mildly regenerative Elevated platelet crit Chem TP 3.8 Glob 1.1 (2.5-4.5) Alb 2.7 (2.2-3.9) K 6.0 (3.5-5.8) Concern for bleeding internal elect sedation for radiographs

9/12/2024

Sedated for radiographs of abdomen and thorax using 0.5ml dexmedetomidine 500mcg/ml and 0.5ml butorphanol 10mg/ml IM Suspicion of mass on R side mid/cranial abdomen On brief ultrasound appears to be possibly cavitated mass or possibly very enlarged bizarre kidney. Unable to visualize kidney or follow possible mass to origin Highly suspicious of neoplasia, especially in light of anemia Recommend hospice placement +/- yunnan baiyao If deteriorating plan EHR

9/12/2024

As per Dr. 1697 sedated for radiographs of abdomen and thorax using 0.5mL dexmedetomidine 500mcg/mL and 0.5mL butorphanol 10mg/mL IM at 1:03 pm. Administered Cerenia 2.8 mL IV Reversed using antesedan 0.5 mL IM at 1:44 pm. Uploaded rads to SB

9/16/2024

Recheck exam Alerted by team that patient vomited blood overnight. Frequency does not appear to be increasing and appears to happen mostly overnight. Also noted nasal discharge and coughing S/O - BAR to QAR, wagging tail and accepting pets. Good appetite per staff. Allows all handling EENT: Eyes clear, mild serous to mucoid nasal discharge noted, erythema over lip. Oral: Pale pink MM, moist H/L: HR 120. No murmurs. Eupneic, lungs clear Abd: Soft and allows palpation, comfortable. Mild tensing when palpating cranial abdomen. No obvious masses palpable MSI: Ambulatory. Multifocal dermal masses throughout of varying sizes Neuro: Bright and appropriate A. Developing mild CIRDC Possible cranial abdominal mass, concern for neoplasia Multifocal dermal masses r/o neoplasia vs benign History of vomiting with blood - intermittent, frequency not increasing at this time History of anemia, low TP - improving! P. Recheck in-house PCV/TS: 30/7.8 (vs HCT 21 TP 3.8 on 9/12) Recheck AFAST: No free fluid. Possible abnormal finding in cranial abdomen, near R kidney, however difficult to visualize; may be associated with kidney itself. No obvious masses otherwise noted. Starting doxycycline 275mg PO SID x 10 days - may elect to stop earlier if causing GI upset Spoke with NH - placement has been found! Recommend placement to pursue further diagnostics such as full abdominal ultrasound and to work with primary veterinarian to maintain quality of life.

9/18/2024

[Dispensing Medication] Doxycycline Tabs 100 mg is being dispensed to the client. In compliance with Bouy's Law, a written client information sheet was included with the prescription. The handout was downloaded from Plumb's™ and discloses all required information regarding the use of this drug, side effects and missed dose and handling instructions.