11/22/2024

Your newly adopted pet has been diagnosed with skin condition and the staff veterinarians are issuing a TEMPORARY waiver from the spay/neuter requirements of the City of NY. Follow up care at your regular veterinarian is recommended to ensure continued treatment through to the resolution of the issue. At the time of a full recovery you may choose to have your veterinarian perform the spay/neuter surgery, or make provisions to return the pet to ACC for sterilization.

11/23/2024

DVM Intake Exam Estimated age: 1-2yr Microchip noted on Intake? Scanned negative History: Stray Subjective: BAR. Happily takes treats. No v/d/c/s. Observed Behavior - Loose body language, very friendly for intake. Is there evidence of Cruelty? No Is there evidence of Neglect? Yes Is there evidence of Trauma? No Objective T = NP P = 80 R = Pant BCS = 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Clean, adult dentition PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non-painful, no masses/fluid wave/organomegaly palpated U/G: Intact male, two symmetrical, descended testicles. MSI: Ambulatory x 4, skin free of parasites, no masses noted. Multifocal to coalescing areas of alopecia with underlying erythematous skin. Lichenification and desqumation present on all affected lesions. Multiple areas of partial thickness ulceration with hemorrhage. Affected areas include calvarium and rostral face (R>L), ventral and dorsal neck (V>D), cranioventral chest, ventral abdomen and inguinal region, lateral aspects of thorax (R>L), left dorsal hip, axillary regions, plantar and palmar aspects of feet. CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally normal Wood's Lamp Exam: NP Assessment: 1) Approx 1.5yr, MI, pitbull mix 2) Multifocal to coalescing areas of erythema, lichenification, ulceration, hemorrhage, scabbing, desquamation and pruritus across body - R/o severe allergies (environmental vs food), parasitic disease (scarcoptes, demodex, fleas, etc), autoimmune disease (phemphigus), contact dermatitis, endocrinopathy, vs other. Prognosis: Fair Plan: 1) Intake tasks performed 2) Nexgard plus administered 3) Please collect HWT at time of neuter. 4) Deep skin scrape (multiple areas): Negative for demodex, sacroptes, cheyletiella 5) Start Cephalexin 500mg - 1 cap po BID x 14d. (11/22pm-12/06pm) 6) Start Gabapentin 300mg capsules - 1 cap po BID x 7d (11/22pm-11/29pm) 7) Start Carprofen 100mg tablets: 1/2 tab po BID x 3d (11/22pm-11/25pm) 8) Start diphenhydramine 50mg - 1 tab po BID x 7d. 9) Start Douxo Chlorhexidine topical mousse: apply to affected areas BID x 14d (11/22pm-12/06pm) 10) Bathe with chlorhexidine based shampoo twice weekly for 4 weeks. 11) Recheck skin day 7 and day 14. Course will likely need to be extended to a 21-28d course. SURGERY: Temporary waiver due to severely inflamed skin. Once skin is under control, can consider neuter.

11/24/2024

Brief recheck of patient this afternoon, as patient appeared depressed in kennel. Patient currently on cephalexin, diphenhydramine, topical douxo, gabapentin, carprofen, twice weekly baths. S/O: QAR in kennel. No v/d/c/s noted. Eating when handfed. PE: Skin subjectively appears less erythematous however lesions appear to be more ulcerated and there are generalized areas that are discharging purulent material. All 4 paws are swollen and discharging purulent material. A: 1) Skin condition deteriorating 2) Cellulitis 3) Draining tracts 4) Depressed mentation R/O: Severe allergies, infectious (fungal, parasitic), autoimmune, endocrinopathy, neoplasia. P: 1) Discontinuing cephalexin and switching to Clavamox. Clavamox 375mg tabs - 1 tab po BID x 14d. 2) Start enrofloxacin 136mg - 2 tablets (~11mg/kg) po SID x 7d. Recheck at end of course and extend if necessary. 3) Requesting CBC/Chem/T4 to be sent out tomorrow 4) Requesting comfort check tomorrow. Add hydro/methadone for pain control? 5) Reached out to NH for placement. 6) If skin not improving, this patient may need a sedated clip and clean, culture/sensitivity, skin biopsies.

11/25/2024

Blood collected for send out CBC/Chemistry/T4

11/25/2024

Progress exam--VAs report patient has become more uncomfortable/painful for topical treatments Subjective: BAR, no c/s/v/d. Takes treats readily Objective: Eyes: Clear bilaterally, no discharge Oronasal: No nasal discharge. Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Severe diffuse pyoderma with ulcerated lesions, swollen paws--unchanged from previous exams. Appears comfortable when moving/walking around and with handling of majority of skin, will flinch and move away when particularly erythematous areas are touched Neuro: Appropriate mentation. Assessment: -Severe diffuse deep pyoderma -Cellulitis -Draining tracts -Depressed mentation (not appreciated today, patient BAR) Plan: -Discontinue topical treatments for now, reassess and restart when possible -Extend carprofen until 12/1, switch to q24h dosing due to time constraints -Continue gabapentin 13 mg/kg PO q12h until 11/29 -Continue clavamox 13.75 mg/kg PO q12h until 12/8 -Continue enrofloxacin 11 mg/kg PO q24h until 12/1 -Recommend culture and sensitivity prior to switching to cephalosporin if lesions do not resolve with current therapy -Awaiting CBC/Chemistry results

11/26/2024

Recheck skin, bloodwork results S/O: BAR, no c/s/v/d noted Severe and diffuse erythema, lichenification, crusting and scabbing, fresh excoriations, serous exudate. Most notable areas affected are right temporal region, ventral neck, limbs (distally more severe), ventrum, inguinum, axillae. CBC: Hct L 34.7, lymphocytes L 0.961 CHEM: phosphorus H 6.8, total protein H 7.8, albumin L 2.0, globulin H 5.8, ALP H 266 T4: L <0.4 A: Severe, diffuse pyoderma and dermatitis with excoriations presumbaly from self trauma Suspect pruritis vs pain Mild anemia - suspect secondary to chronic dz (skin) Hypoalbuminemia, Hyperglobulinemia - suspect secondary to severe, chronic skin disease Low T4 - ro euthyroid sick vs hypothyroid P: Start apoquel 13.4 mg PO BID today and then 8 mg PO BID x 10 days (*only have two tabs of 5.4mg apoquel in stock, otherwise only have 16mg tabs in stock) Continue clavamox and enrofloxacin Discontinue diphenhydramine as unlikely to be effective for this severe of skin condition Continue gabapentin for pain Hold off on any topical treatments for now due to worsening of skin after treatments (unknown if coincidence or cause). Consider gentle bathing every few days if skin not worsening. Did not place e-collar due to significant lesions at ventral neck Consider switching from carprofen to pred (with washout period) if not improving Monitor closely! Seek placement for continued treatment outside shelter with regular bathing and cleaner environment

11/26/2024

Bath today with lukewarm water and malaseb shampoo. Rinsed thoroughly.

11/27/2024

E-collar placed to help mitigate self-trauma.

11/29/2024

Brief skin recheck S/O: BAR, allows handling, e-collar in place. Bedding soiled/dirty with food, discharge, possibly feces (prior to AM cleaning) Eating well No c/s/v/d noted Lesions along body and head are improved with dry, dark crusts and mild erythema/light pink skin Lesions at medial thighs, inguinum, axillae, and paws remain moist, erythematous, with serous to purulent discharge Ventral neck where e-collar is in contact appears stable/no worse A: Severe pyoderma, dermatitis Allergies likely Mild anemia Hypo albuminemia, hyperglobulinemia- suspect secondary to severe, chronic skin disease Low T4 - ro euthyroid sick vs hypothyroid P: Bathe today with lukewarm water and malaseb Continue clavamox, enrofloxacin, apoquel, carprofen CTM closely in ICU

11/30/2024

Addendum, post bath: Right side of face very pruritic with severe, diffuse mottling of skin red to purple in color, friable and bleeds easily. Ventral neck similar with excoriations from e-collar rubbing. Applied SSD to most severe lesions, applied telfa and padded bandage to neck and then placed e-collar.

12/2/2024

Reason for recheck: monitoring skin/overall condition. S/O: Patient currently on clavamox, enrofloxacin, apoquel, carprofen. BAR, up at front of kennel and wagging tail. Patient is eating well and readily accepts treats. No c/s/v/d noted. Received malaseb bath yesterday. Allows handling, e-collar in place. PE: Lesions along body and head appear improved from last examination. No obvious discharge from lesions. Lesions present on body (inguinal region, medial thighs, axilla) appear to be more dry than last examination, however they are still very erythematous with dried/crusted dark brown scabs. Feet appear subjectively less swollen. Digit 5 on right hind has a small amount of frank blood present at base of nail after being brought in from walk. A: Severe pyoderma, dermatitis - slowly improving Allergies likely Mild anemia Hypo albuminemia, hyperglobulinemia- suspect secondary to severe, chronic skin disease Low T4 - ro euthyroid sick vs hypothyroid P: 1) Restart gabapentin 300mg tabs for additional pain control: 1 cap po BID x 7d (12/2-12/9) 2) Extend carprofen through 12/4 (3 additional days) - 100mg, 1 tab po SID x 3d (12/2-12/4) 3) Recheck tomorrow and put SSD cream on most lesions. 4) Replace/rebandage e-collar tomorrow, if needed. 5) Schedule for bath with malaseb/luke warm water 12/3. 6) Continue clavamox, enrofloxacin, apoquel. 7) Recheck 12/4 - clavamox/enro/apoquel end 12/8 and will likely need to be extended. 8) CTM closely in ICU

12/2/2024

Malaseb bath, use lukewarm water done by VA

12/3/2024

Spots received a bath today with malaseb and luke warm water. The bandage on his neck was removed. S/O: Skin slowly appears to be improving. Generalized scabbing present over all areas of alopecia but no draining tracts. Patient appears more comfortable and does not have "skin crawling" during examination today. Patient does appear pruritic on face and rubs face on to towel/handlers body when able to. Patient continues to eat well. No v/d/c/s. Ventral neck, inguinum, dorsum, limbs, and face appear erythematous with lichenification and scabbing. Mild blepharospasm of OD with no ocular discharge. Abd palpation is WNL. Heart and lungs not auscultated today. A: Severe pyoderma, dermatitis - slowly improving Allergies likely Mild anemia Hypo albuminemia, hyperglobulinemia- suspect secondary to severe, chronic skin disease Low T4 - ro euthyroid sick vs hypothyroid P: 1) Bathed today - consider bathing again 12/4. 2) Thin layer of SSD cream applied to affected areas. 3) Neck bandage replaced - SSD cream, telfa pads (4 used), cast padding, vet wrap. Change bandage at time of bath. 4) Continue gabapentin, carprofen, enroflox, clavamox, apoquel 5) CTM closely in care

12/4/2024

Issue List: - demodicosis - dermatitis BAR H EENT: right side facial alopecia and marked dermatitis H/L: eupneic PLN: WNL ABD: relaxed U/G: MI MSI: Ambulatory x 4, multifocal areas of alopecia and dermatitis CNS: Mentation quiet - no signs of neurologic abnormalities A) r/o demodex vs other P) Repeat skin scarp- positive for demodex Apoquel- discontinued; apparently should not be used during demodex treatment but NSAIDS seem okay Nexgard- 2.5 mg/kg q 14 d's till scrapes negative (for about 2 months) Continue Ab's- enrofloxacin- 20 mg/kg q 24 hrs discontinue clavamox Enrofloxacin- 204 mg sig: 2 tabs po q 24 hrs x 14 d's AND Enrofloxacin- 22.7 mg sig: 1 tab po q 24 hrs x 14 d's

12/4/2024

malaseb bath - please use lukewarm water. Has neck bandage that will need to be removed/changed at time of bath Done by VA