9/27/2019

DVM Intake Exam Estimated age: ~10-11 yr Microchip noted on Intake? None History : Found tied outside Subjective: BAR Observed Behavior - Nervous with medical handling, required muzzle Evidence of Cruelty seen - No Evidence of Trauma seen - No Objective T = NT P = WNL R = WNL BCS 4/9 EENT: LS OU, menace present OU, significant debris and erythema AS, moderate debris with no erythema AD, no nasal or ocular discharge noted, possibly deaf Oral Exam: patient muzzled so limited oral exam, able to assess incisors and left maxillary canine with muzzle on-severe dental disease PLN: No enlargements noted though unable palpate submandibular and prescapular lymph nodes due to patient compliance H/L: NSR, difficult to auscult due to panting, but no obvious HM, CRT < 2, Lungs clear, panting ABD: Tense, non painful, unable to deeply palpate U/G: MI-2 testicles descended, smooth/symmetrical MSI: Ambulatory x 4, skin free of parasites, ulcerated dermal mass on left side of dorsum, slightly unkempt hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Assessment: ~10-11 yr MI Pitbull Mix Geriatric LS OU Dental disease Otitis AU Mass-r/o benign vs malignant +/- deaf Prognosis: Fair Plan: Ear cleaning AU Applied oti-pack (enrofloxacin, ketoconazole, triamcinolone) 3 ml applied AU Will need follow up in 1 week to recheck ears. Will need neuter, dental, mass removal with biopsy with preop CXR and full blood work SURGERY: Waiver for surgery due to age

10/8/2019

Progress exam History : Intake 9/27/19-geriatric, dental disease, otitis, mass, possibly deaf. Cleaned ears and applied otipak. Subjective: BARH. Some head whipping and whale eyes but low tail wag. Sneezing/coughing. Objective P = wnl R = wnl BCS = 4/9 EENT: Eyes have nuclear sclerosis ou, ears hae thick ointment AU, moderate serous nasal d/c Oral Exam: adult dentition with grade 2 dental disease, no oral lesions PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI, 2 testicles descended MSI: Ambulatory x 4, skin free of parasites, dry hair coat, ~0.5cm dermal mass on dorsum between shoulder blades CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Geriatric Dorsal mass between shoulder blades CIRDC Dental disease Otitis externa +/- Deaf-did not assess today Prognosis: Fair Plan: CTM while at BACC Move to iso Start baytril 10mg/kg PO SID x14d until 10/22 Start doxycycline 10mg/kg PO SID x14d until 10/22 Rec neuter, dental, BW, histopath of mass, CXR with placement

10/15/2019

Progress exam History : Intake 9/27/19-geriatric, dental disease, otitis, mass, possibly deaf. Cleaned ears and applied otipak. 10/8-started on doxycycline and baytril for CIRDC Subjective: BAR. No csvd. Great appetite. Objective EENT: Eyes have nuclear sclerosis ou, no nasal or ocular d/c H/L: Normal RR/RE, eupneic MSI: Ambulatory x 4 CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Geriatric Dorsal mass between shoulder blades Dental disease Otitis externa +/- Deaf-did not assess today Prognosis: Fair Plan: CTM while at BACC Continue baytril 10mg/kg PO SID until 10/22 Continue doxycycline 10mg/kg PO SID until 10/22 Rec neuter, dental, BW, histopath of mass, CXR with placement Ok to move out of iso

10/22/2019

History 9/27/19 stray intake: geriatric, dental disease, otitis, mass, possibly deaf. Cleaned ears and applied otipak. 10/8: started baytril and doxycycline for CIRDC Today 10/22: bleeding mass noted at back S/O: BAR, active at front of kennel, no c/s/v/d noted. EENT: Eyes nuclear sclerosis OU, no nasal discharge noted Lungs: Eupneic, normal rate and effort MSI: Ambulatory x 4, dermal nodule ~1.5cm at dorsum at level of shoulders: ulcerating with mild hemorrhage. Harness sitting directly adjacent to mass. CNS: Mentation appropriate A: Dorsal mass between shoulder blades - ulcerated (likely from harness) Dental disease Geriatric Nuclear sclerosis Otitis externa - treated 9/27 +/- Deaf - did not assess today P: Recommend removing harness while in kennel so inflamed/ulcerated mass can heal CTM while at BACC Recommend bloodwork, CXR, neuter, histopath of mass with placement SURGERY: Okay for surgery Temporary waiver due to Permanent waiver due to

10/27/2019

Progress exam History 9/27/19 stray intake: geriatric, dental disease, otitis, mass, possibly deaf. Cleaned ears and applied otipak. 10/8: Started baytril and doxycycline for CIRDC 10/22: bleeding mass noted on back, recommended removing harness. Today, 10/27: Recheck mass Subjective: BAR, no coughing/sneezing/vomiting/diarrhea Objective: Eyes: Clear bilaterally, no discharge Nasal Cavity: No nasal discharge. Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Integument: Ulceration appears to be healing normally with bed of granulation tissue present. Neuro: Appropriate mentation. Assessment: -Dorsal mass between shoulder blades - ulcerated (likely from harness) -Dental disease -Geriatric -Nuclear sclerosis -Otitis externa - treated 9/27 +/- Deaf - did not assess today Plan -Leave harness while in kennel so inflamed/ulcerated mass can heal -CTM while at BACC -Recommend bloodwork, CXR, neuter, histopath of mass with placement

10/30/2019

Patient did not respond to multiple auditory stimuli on examination. Suspected to be deaf.

11/10/2019

Progress exam History : Intake 9/27/19-geriatric, dental disease, otitis, mass, possibly deaf. Cleaned ears and applied otipak. 10/8-started on doxycycline and baytril for CIRDC (resolved 10/15) 10/30-suspected to be deaf, did not reply to auditory stimuli Subjective: BARH. No csvd. Very friendly. Objective P = wnl R = wnl BCS = 4/9 EENT: Eyes have nuclear sclerosis ou, ears clean but mildly pruritic, no nasal or ocular discharge noted Oral Exam: adult dentition with mild dental disease, no oral lesions PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI, 2 testicles descended MSI: Ambulatory x 4, skin free of parasites, small dermal mass between shoulder blades, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Geriatric Dorsal mass between shoulder blades Dental disease Deaf Prognosis: Fair Plan: CTM while at BACC Rec neuter, dental, BW, histopath of mass, CXR with placement

11/18/2019

Progress exam History : Intake 9/27/19-geriatric, dental disease, otitis, mass, possibly deaf. Cleaned ears and applied otipak. 10/8-started on doxycycline and baytril for CIRDC (resolved 10/15) 10/30-suspected to be deaf, did not reply to auditory stimuli Subjective: Foster reports inability to walk up stairs, must be carried. BARH. No csvd. Objective P = wnl R = wnl BCS = 4/9 EENT: Eyes have nuclear sclerosis ou, ears clean, no nasal or ocular discharge noted Oral Exam: adult dentition with mild dental disease, no oral lesions PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI, 2 testicles descended MSI: Ambulatory x 4 with no lameness noted, creptius in the left stifle and limited extension in both hips and stifles, limited flexion in both shoulders, decreased muscle mass in HLs, skin free of parasites, small dermal mass between shoulder blades, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Geriatric Suspect OA Dorsal mass between shoulder blades Dental disease Deaf Prognosis: Fair Plan: CTM while at BACC Rec neuter, dental, BW, histopath of mass, CXR with placement Rec joint supplements, +/- NSAIDs with placement. Difficult for him to go up stairs so recommend home without stairs. Will need regular exercise Start rimadyl 4.4mg/kg PO SID until placement as long as BW looks ok, scheduled for tomorrow

11/19/2019

Bloodwork interpretation CBC: mild non-regenerative anemia (Hct 36.8) Chem: mild to moderate azotemia (Creatinine 2.5, BUN 51) Assessment: Azotemia, mild to moderate- r/o pre-renal v renal (CKD, acute on chronic renal disease, toxin, neoplasia Suspect OA Dorsal mass between shoulder blades Dental disease Deaf Prognosis: Guarded Plan: Scheduled for UA tomorrow Rec neuter, dental, AUS, histopath of mass, CXR with placement Rec joint supplements, physical therapy with placement. Difficult for him to go up stairs so recommend home without stairs. Will need regular exercise Due to elevated renal values, had to d/c carprofen and switch to gabapentin. Recheck chemistry in 2 weeks

11/20/2019

UA interpretation: Given that USG was 1.018 (low-normal), renal disease (specifically CKD) is suspected. Recommend AUS, urine culture with placement

Upon intake, Pistachio was curious. He pulled hard on the leash. When the microchip scanner was presented to him, he moved toward it very quickly but did not growl. He was not nervous about the scanner being passed around his body, and took treats from client care.