9/4/2024

DVM Intake Exam Estimated age: 3-5y Microchip noted on Intake? scanned negative History: Stray found in lobby of building Subjective: BAR Observed Behavior - Tense, but allows 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 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition with moderate tartar PLN: No enlargements noted H/L: NR, NMA, Lungs clear, eupneic ABD: Non painful, no masses palpated 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 apparently healthy Prognosis: good Plan: intake tasks neuter new home SURGERY: Okay for surgery

9/12/2024

Sniffling and sneezing with serous nasal dc A: URI-mild P: fortiflora 1 sachet PO SID x7d

9/14/2024

Yellow mucoid nasal discharge noted during cage side rounds. Hissing, food bowls empty. A: Moderate URI Eating P: Rx: Doxycycline 50mg/ml 1.2 ml PO SID x10d

9/14/2024

Staff noted lethargy/laying in litterbox and not moving. When placed in carrier is hissing/growling and tense when handled. P: Add on nebulizations Monitor energy No space in medical at this time

9/17/2024

Progress exam: URI S/O: QAR, resting in litterbox. Hard swallowed and gagged several times when offered food and turned head away. Mild amount mucoid discharge at nares, no obvious stertor or audible congestion. Prolonged skin tent, slightly tacky mm. A: Anorexia Lethargic Dehydrated ~7% *URI - moderate, continued P: Continue with doxycycline, started on 9/14-9/24 Start supportive care today: -LRS SQ 100ml SID x 3 days -Cerenia 0.6ml SQ x 3 days -Mirtazapine transdermal x 3 days -Tempt with tasty foods *DVM recheck in 2 days (9/19) to extend supportive care

9/19/2024

Recheck URI S: Laying down in bed, food bowls untouched. O: EEN- eyes clear, yellow nasal discharge but no ocular discharge noted H/L- Eupneic, but moderate audible congestion Neuro-alert appropriate A: URI moderate Not eating P: Extending supportive care Adding back on nebulizations SID x3d Leaving in holding at this time due to previously noted high FAS Discuss ARL

9/20/2024

Progress exam: URI S/O: Dull and curled up in bed in kennel. Appears shut down and lethargic, but leaning in to head rubs a bit. Turning away when food offered, gagged once. Some doxy yellow staining around mouth, some drooling. Crusted discharge around nares, audible upper respiratory congestion. Mildly prolonged skin tent. Pink mm, crt<2 secs. Normal lung sounds bilaterally. A: Anorexia noted since 9/14 - continued Lethargic Dehydrated <5% - continued *URI - moderate, continued P: Moved into Medical Iso for closer monitoring and quieter environment; placed Kuranda bed in kennel to provide options with space. Once P moved into Medical Iso, appeared less shut down in kennel, leaned further into head rubs and lifted bum when scratched several times. *Continue with doxycycline, started on 9/14-9/24 *Yellow PPE during handling *Extend supportive care x 3 days (thru 9/23): -LRS SQ 100ml SID q24h -Cerenia 0.6ml SQ q24h -Mirtazapine transdermal q24h -Continue to tempt with food *DVM recheck on 9/21 *P needs placement ASAP to get him out of the shelter environment, as severity of condition likely due to high stress. He will need a quiet place to recover.

9/21/2024

Recheck URI S/O: Quiet and curled up in bed. AS noted as 2-3, full wet food bowl noted in kennel. Environment is loud at time due to barking dog in iso, patient hides head under paw. ~5% dehydrated (mild delayed skin tenting) EENT: Mild mucoid discharge and crusting around nares. Mild serous ocular discharge. Mild congestion Oral: No oral ulcers noted EENT: No murmurs, mild wheezes heard on both lungs, quiet referred upper respiratory noises Abd: Soft, non painful MSI: Appropriate muscling, ambulatory. No skin lesions Neuro: Quiet but appropriate A: Anorexia noted since 9/14 - possible mild improvement (AS 2 noted once) Lethargic Dehydrated <5% - continued *URI - moderate, continued P: Continue with treatments: - doxy until 9/24 - LRS until 9/23 - Cerenia until 9/23 - Miratax until 9/23 Start medical feeds though 9/23 OK to discontinue nebulization at this time to reduce FAS Recheck appetite 9/22 and at end of supportive care to extend as needed P needs placement ASAP to get him out of the shelter environment.

9/22/2024

Issue List: - URI - Anorexia - FAS Visual exam; hissing QAR not eating well EENT: no nasal discharge noted H/L: eupneic U/G: MI MSI: Ambulatory x 4 CNS: Mentation quiet - no signs of neurologic abnormalities A) URI; anorexia P) CWSC

9/23/2024

Food dishes untouched. Pet lying on bed. Slowly raises head when I bring food dish to mouth. He sniffs and licks his lips but doesn't eat. Leans into pets. Weight: 11.4# Temp: 101.7 RR: 24 HR: 160 EEN: No ocular or nasal discharge. No nasal congestion noted. Oral: No oral lesions. Swallowing doesn't appear to take extra effort. CV/RESP: Increased BV sounds. No crackles or wheezes. RE WNL. NR. NMA ABD/UG: SNP NMP. Male intact MSI: Decreased skin turgor. Ambul x 4 NEURO: QAR. Persistently tries to flee during exam. A: Day 9 of URI Anorexia persists despite doxycycline, SQF, cerenia and mirtazapine. Weight loss Lethargy in cage but active out of cage. Prognosis: Fair Pet seems interested in food. Appetite might improve off of doxycycline. r/o viral +/- side effect of medication P: Discontinue Doxycycline Offer variety of food textures

9/24/2024

Issue List: - anorexia for several days - weight loss - BAR H QAR DH EENT: no nasal or ocular discharge noted; nothing under tongue H/L: eupneic PLN: WNL ABD: relaxed U/G: MC/MI/FS/FI MSI: Ambulatory x 4, normal hair coat CNS: Mentation quiet - no signs of neurologic abnormalities A) - anorexia - diagnosed with URI - weight loss P) Sedation: Telazol- 0.14 ml IM Radiograph Results: no ingesta in stomach or colon; no obvious FB noted CBC/CHEM- pending

9/25/2024

SO: In medical isolation on treatment for URI and anorexia BAR, comes to kennel door seeking attention. Head butting and purring. Allows all handling eent: eyes clear, no ocular or nasal dc apparent h/l: eupneic, no coughing or sneezing appreciated msi: ambulatory x4 neuro: mentation alert and appropriate A: URI clinical signs not appreciated P: Unable to tell if eating a little if appetite not improved tomorrow, consider addition of transdermal mirtazapine CBC/chem at lab unremarkable

9/26/2024

SO: In medical on treatment for anorexia and URI symptoms. URI symptoms improving, but appetite is not. Recent btr unremarkable BAR, head butting and seeking attention, untouched food plates in kennel eent: eyes clear, no ocular or nasal dc apparent h/l: eupneic, no coughing or sneezing appreciated msi: ambulatory x4 neuro: mentation alert and appropriate A: anorexia P: starting mirataz for 3 days 1/5" strip applied to ear once daily for 3 days

9/30/2024

QAR, sitting at door of cage. Eating dry food. Chews on kibble a little longer than average cat. EEN: No ocular or nasal discharge RESP: Eupneic A: Appetite improving without stimulant Prognosis: Fair Plan Offer variety of dry food.

10/1/2024

Pet ate some dry food overnight and tuna during rounds. He leans into pets. EEN: no ocular or nasal discharge. RESP: Eupneic ABD/UG: MI. Doughy abdomen MSI: Decreased skin turgor. Ambul x 4 NEURO: QAR A: Appetite is better but not great. Dehydrated. Cat may be on the upswing in his recovery from viral URI Plan LRS 125 mls sq sid x 3days Advise seek placement

10/2/2024

PROGRESS EXAM AS2 overnight and throughout today. Ate almost all of dry food, and was seen licking at wet food. Particularly when enjoyed head and bum rubs. Leaning into pets. S/O: EEN: slightly crusty brown ocular discharge at medial canthi. No nasal discharge. RESP: Eupneic ABD/UG: MI. Doughy abdomen MSI: well hydrated, normal skin turgor. Ambulatory x 4 NEURO: appropriate and alert A: Hyporexia - much improved today Dehydrated - improved today *URI resolving Plan Finish course of LRS SQ Continue to seek placement

10/4/2024

Recheck appetite, URI signs resolved 10/1 S: BAR, comes to kennel door seeking attention/head bunting. Meow Mix plate eaten in its entirety, but remaining food bowls untouched. O: EEN- eyes clear, no ocular or nasal discharge H/L- Eupneic, no sneezing or audible congestion MSK/i- Ambulatory x4, healthy haircoat Neuro-alert appropriate A: URI- resolved Eating some, possible social eater P: Monitor appetite closely

10/5/2024

Hx: decreased appetite, monitoring S: BAR, head bunting, ate dry food well o/n. O: EENT: Eyes clear, no ocular or nasal discharge noted H/L: Eupneic MSI: Ambulatory x 4, healthy hair coat CNS: Mentation appropriate/ alert A: Eating P: Ok to move out of med iso Continue to monitor

10/22/2024

Pre-surgical exam, anesthesia, and surgery performed by offsite vet. Medical record uploaded to Vet Documents. Green linear tattoo placed lateral to incision.

10/29/2024

Feeding Tube Placement left side of lateral neck surgically prepared; small incision made over lateral neck skin and esophagus using a hemostat down the oral cavity and tenting the esophagus and skin on the left side; 18 gauge red rubber French tub placed (after being partially cut down by about 1/3); secured with a purse string knot and then 2 crisscross interlocking sutures (3-0 pds). Post placement rads- tube end at 7-8 intercostal space Feeding instructions: Flush with 5 ml water Give 1/3 can of critical nutrition diet with some water to make it soupy and place down tube slowly over 10-15 minutes (amount should not exceed 30 ml in the syringe) Flush again with 5 ml water Fluid therapy: Fill fluid bag with 200ml tap water and attach IV tubing to the end of the feeding tube. Set the fluids on a slow drip (about 1 drop/2-3 seconds).

10/29/2024

DVM Intake Exam Estimated age: 3 years Microchip noted on Intake? scanned positive History: return from adoptions, cat is not eating, URI Subjective: dull mentation, quite sick Observed Behavior - reluctant to move, drooling Is there evidence of Cruelty? No Is there evidence of Neglect? NO Is there evidence of Trauma? NO Objective BCS: 5/9 EENT: Eyes squinted, elevated 3rd eyelid, ears clean, nares occluded with crust and blood oral: tongue has multiple ulcers, necrosis on mandibular gums and nasal planum, off-white plaques on dorsal tongue papillae, copious amounts of saliva in mouth PLN: sub-mandibular ln enlarged H/L: NMA, CRT < 2, cranial lung field muffled, eupneic ABD: Non painful, no masses palpated U/G: neutered male - blood and scabs on scrotum, scrotum inflamed, MSI: Ambulatory x 4, skin free of parasites, no masses noted, dull hair coat CNS: Mentation dull due to illness Assessment: oral ulcers, severe URI, Prognosis: fair/ guarded Plan: intake tasks cleaned crusts and scabs off nares and scrotum - 0.48 ml DKT IM for sedation / Antiseden 0.12 IM - Zorbium 20 mg/ 1 ml topical - Convenia 0.6 ml SQ - to place feeding tube - move cat to MEDICAL ISO - 0.25 ml Kitty Magic Mouthwash - 150 ml Fluids SQ - feeding tube rate 1 drop/ second water SURGERY: Permanent waiver due to already altered

10/30/2024

Previous veterinary records added under "veterinary documents" Patient seen by Rutherford Animal Hospital on 10/26/24/ Summary of documents: Date: 10/26/24: Reason for visit: P presents for suspect upper respiratory infection since Thursday. P was adopted on Wednesday & neutered by shelter on Tuesday (4 days ago). P has history of anorexia and upper respiratory infection in past per shelter. No issues on Wednesday. Thursday became congested. Last ate Thursday. Not eating. Owner has not seen patient drinking. Nasal discharge mucus and bloody. PE from 10/26: Patient was found to be dehydrated, QAR, hemorrhagic nasal d/c, congested, had referred upper respiratory sounds, scrotum was inflammed/swollen (suspect seroma). Assessment from 10/26: 1) pyrexia - infection 2) Hyporexia - r/o pain, infection/inflammation, other. 3) URI - infection/inflammation, allergies/FB 4) Scrotal swelling - R/O seroma, infection, trauma, other. Plan 10/26: 1) Performed SQF 100mL 2) Convenia 0.5mL SQ LH limb 3) Revolution applied (11.1-22lb) 4) Given mirataz topically 5) Given robenacoxib tablets - 1 tab po SID x 3d.

10/30/2024

TID tube feedings have been successfully completed. Administered 1/3 can of CN slurry each feeding. Flushed with 5 ml of water before and after each feeding. Pet did not vomit.

11/1/2024

Hx: severe upper respiratory infection with oral ulceration, feeding tube placed 10/29 S: quiet/dull in back of kennel, no vomit in kennel, urine in litterbox O: EEN- epiphora OU, bleeding nasal planum Oral exam- white plaques on tongue, scabbing on chin and upper lip is bleeding profusely, hemostasis achieved when pressure applied H/L- Tachypnea, lungs clear, referred upper airway noises MSK/i- Ambulatory x4, but prefers to lay down Neuro- dull A: Severe URI Oral ulcerations with bleeding Painful Dull mentation Anorexia with feeding tube P: Apply Zorbium Seek placement ASAP vs. EHR due to severity of discomfort and inability to appropriately manage in shelter