11/9/2021

DVM Intake Estimated age: 11 years Microchip noted on Intake? Yes History: Owner surrender Subjective: BARH, no coughing/sneezing/vomiting/diarrhea Observed behavior: Wide eyes, allowed handling with towel for exam. Growling and hissing for intake tasks Evidence of cruelty seen: No Evidence of trauma seen: No Objective: P: WNL R: WNL BCS: 6/9 OP: Mucous membranes pink and moist. CRT <2. Stage III dental disease. EENT: Eyes, ears, and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful CV: Grade III heart murmur. No arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Soft, nonpainful, no palpable masses. UG: female spayed, scar noted, no discharge INT: Good hair coat, no areas of alopecia or pruritus, no ectoparasites or masses noted. MS: Ambulatory x4, no pain on palpation of epaxials NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Assessment: -Grade III heart murmur -Stage III dental disease Prognosis: Fair Plan: -Recommend dental cleaning, cardiology consult with placement Surgery: Spayed

1/20/2022

DVM Intake Estimated age: 11 years Microchip noted on Intake? Yes History: o/s - behavioral reasons toward a newly adopted kitten Subjective: BAR, 5-8% dehydration. No c/s/v/d Observed behavior: Approaches to head butt and likes being pet but pulls away if trying to interact more. When removed from cage, wide eyes, allowed handling with towel for exam. Growling and hissing and biting at towel at times during exam and tasks. Needed sedation to execute full exam and tasks. Evidence of Cruelty seen -n Evidence of Trauma seen -n Objective T = P = 200 R =eup BCS= 3/9 EENT: Eyes - mild nuclear sclerosis, ears clean, no nasal or ocular discharge noted Oral Exam: fleshy irregular oblong 1 cm mucosal mass R caudal mandible between gingiva and cheek- bleeding upon exam; marked tartar and gingivitis, painful on the R side PLN: No enlargements noted H/L: NSR, 3/6 murmur, MM pk, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated, rounded kidneys U/G: female, no discharges, no MGT's MSI: Ambulatory x 4, skin free of parasites, no masses noted, unkempt dry hair coat, thin with muscle wasting CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: visually unremarkable Wood's Lamp Exam: Assessment: Senior FS DSH 1) Underweight 2) Dehydrated 3) Dental dz -stage 3-4 4) Oral mass - r/o neoplasia (eg. SCC) vs proliferation due to ddz (epulis) 5) Suspect renal dz based on low SpGr 6) Heart murmur 3/6 Prognosis: Guarded to poor Plan: Sedated: Dexdom/ ket/ torb 0.05 cc each. Reversed with antisedan. Good sedation and recovery. 1. Bloodwork pending - CBC/ Chem/ T4 2. Urine - only able to get enough for SpGr=1.016 3. Xrays - 3 views - Chest - several small opacites throughout lungs but does not appear to be masses - r/o prominent broncho-interstitial pattern due to age vs miliary pattern (possibly metastasis). Heart NSF. Arthritic changes for ribs. Abd- rounded kidneys, intestines NSF, liver WNL, no masses noted 4. 100 cc SQF 5. In medical - to monitor eating and re-check hydration if possible Given the age of the cat and appearance of the mass, neoplasia is suspected. Consider FNA/ cyt or bx to confirm but concurrent illness (heart murmur, suspect renal dz) make this patient not a good candidate for adoption or staying in the shelter. Consider rescue. Re-assess based on BW and monitoring in medical. Surgery: Spayed

1/21/2022

Progress exam History: Intake 1/20/2022: Owner surrender, previously at BACC 11/9/2021. Noted underweight, dehydrated, dental disease, oral mass, suspect renal failure. Performed bloodwork, three view thoracic radiographs. Gave LRS once Today, 1/21: Progress exam Subjective: BAR, very mild skin tent. No coughing/sneezing/vomiting/diarrhea, excellent appetite. Initially leans into petting, escalates to hissing if more handling is attempted. Objective: Limited exam due to behavior R: WNL BCS: 3/9 OP: Does not allow EENT: Nuclear sclerosis OU, ears and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful RESP: Eupneic INT: Good hair coat, no areas of alopecia or pruritus, no ectoparasites or masses noted. MS: Ambulatory x4, no pain on palpation of epaxials. Moderate diffuse muscle wasting NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. CBC: Mild non-regenerative anemia [RBC 6.1 (7.12-11.46 M/uL), HCT 28 (28.2-52.7%)] Mild lymphopenia .074 (0.85-5.85 K/uL) Mild monocytosis 0.95 (.04-0.53 K/uL) Chemistry: Mild-moderate azotemia [SDMA 20 (0-14 ug/dL), creat 2.4 (0.9-2.3 mg/dL), BUN 65 (16-37 mg/dL)] T4: WNL Assessment: -Suspect early CKD -Underweight -Dehydrated -Grade III dental disease -Grade III/VI heart murmur -Oral mass -Mild radiographic changes--on re-exam, opacities within lungs appear to be consistent with end-on vessels. Likely age-related changes. Prognosis: Fair to guarded Plan: -Start LRS 20 ml/kg SQ q24h x 3d until 1/23 -Start renal diet only -Keep in medical, monitor appetite and hydration -Recommend IM consult +/- cardiology consult, FNA of oral mass--may require lifelong management for CKD

1/22/2022

BAR in kennel, excellent appetite, euhydrated. Continue with current treatment plan, keep in medical and monitor closely.

1/23/2022

Progress exam History: Intake 1/20/2022: Owner surrender, previously at BACC 11/9/2021. Noted underweight, dehydrated, dental disease, oral mass, suspect renal disease. Performed bloodwork, three view thoracic radiographs. Gave LRS once. 1/21: Moderate azotemia noted Today, 1/23: Progress exam Subjective: BAR, euhydrated, no coughing/sneezing/vomiting/diarrhea. Good appetite, eating kidney diet well. Seeking attention today, allowed petting Objective: R: WNL BCS: 3/9 EENT: Nuclear sclerosis OU, nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful RESP: Eupneic INT: Good hair coat, no areas of alopecia or pruritus, no ectoparasites or masses noted. MS: Ambulatory x4, moderate diffuse muscle wasting NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Assessment: -Suspect early CKD -Underweight -Dehydrated (resolved) -Grade III dental disease -Grade III/VI heart murmur -Oral mass Prognosis: Fair to guarded Plan: -Okay to d/c LRS -Continue renal diet only -Keep in medical, monitor appetite and hydration -Recommend IM consult +/- cardiology consult, FNA of oral mass--may require lifelong management for CKD

1/24/2022

History 1/20/22 os intake, RTS (previously at BACC 11/9): underweight, dehydration, dental disease, oral mass, suspected CKD; sedated due to behavior, bw and rads performed, low USG noted; SQF given once 1/21: azotemia noted on bw; started renal diet and SQF Today, 1/24: progress exam S/O: BAR, purring and leaning into petting until oral exam attempted, growls and head whips. Eating well, no c/s/v/d noted. EENT: No ocular or nasal discharge noted Oral: limited - pink/inflamed mass noted at right side of mouth - growls upon touching that side of her mouth H/L: Eupneic, normal respiratory rate/effort ABD: No obvious distention MSI: Ambulatory x 4, no notable lameness; dorsal muscle wasting and underweight CNS: Mentation appropriate A: Chronic kidney disease Underweight Dental disease Oral mass - ro neoplasia (SCC) vs oral inflammation secondary to ddz (epulus) vs other Heart murmur P: Continue to monitor weight, appetite, energy, etc while at BACC Recommend cardiology consult with echo, dental procedure with biopsy of mass.

1/25/2022

History 1/20/22 os intake, RTS (previously at BACC 11/9): underweight, dehydration, dental disease, oral mass, suspected CKD; sedated due to behavior, bw and rads performed, low USG noted; SQF given once 1/21: azotemia noted on bw; started renal diet and SQF Today, 1/25: progress exam S/O: BAR, initially allows handling/petting, but hissing/growling when attempting oral exam; eating well, no c/s/v/d noted. EENT: No ocular or nasal discharge noted Oral: did not perform due to temperament H/L: Eupneic, normal respiratory rate/effort MSI: Ambulatory x 4, no notable lameness; dorsal muscle wasting and underweight CNS: Mentation appropriate A: Chronic kidney disease Underweight Dental disease Oral mass - ro neoplasia (SCC) vs oral inflammation secondary to ddz (epulus) vs other Heart murmur P: Continue to monitor weight, appetite, energy, etc while at BACC Recommend cardiology consult with echo, dental procedure with biopsy of mass.

1/26/2022

History 1/20/22 os intake, RTS (previously at BACC 11/9): underweight, dehydration, heart murmur, dental disease, oral mass, suspected CKD; sedated due to behavior, bw and rads performed, low USG noted; SQF given once 1/21: azotemia noted on bw; started renal diet and SQF Today, 1/26: progress exam S/O: BAR, allows some petting, but escalates to hissing, growling, swatting. Handled with towel in order to perform thorough oral exam. Decreased appetite today (food minimally touched overnight), no c/s/v/d noted. EENT: No ocular or nasal discharge noted Oral: right pm mobile with severe calculus, malodor, off white discharge, and associated gingivitis; proliferative tissue associated with mobile tooth at buccal gingiva - does not appear to be a mass H/L: Eupneic, normal respiratory rate/effort MSI: Ambulatory x 4, no notable lameness; dorsal muscle wasting and underweight CNS: Mentation appropriate A: Chronic kidney disease Underweight Dental disease - severe with mobile/infected right max pm and associated stomatitis/gingivitis Heart murmur Senior pet P: Scheduled convenia injection Start simbadol 0.24 mg/kg SQ SID x 3 days to ease possible oral pain Continue to monitor weight, appetite, energy, etc while at BACC Recommend UA/UCS, cardiology consult with echo, and dental procedure with xrays/extractions with palcement

1/28/2022

Progress exam History: 1/20/22 os intake, RTS (previously at BACC 11/9): underweight, dehydration, heart murmur, dental disease, oral mass, suspected CKD; sedated due to behavior, bw and rads performed, low USG noted; SQF given once 1/21: azotemia noted on bw; started renal diet and SQF 1/26: Poor appetite noted, started simbadol and gave convenia Today, 1/27: progress exam Subjective: QARH, no coughing/sneezing/vomiting/diarrhea. Picking at wet food. Objective: P: WNL R: WNL BCS: 3/9 EENT: Eyes, ears, and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful CV: Grade III/VI heart murmur, no arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Soft, nonpainful, no palpable masses. INT: Rough haircoat, no areas of alopecia or pruritus, no ectoparasites or masses noted. MS: Ambulatory x4, moderate diffuse muscle wasting NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Assessment: -Chronic kidney disease -Underweight -Dental disease - severe with mobile/infected right max pm and associated stomatitis/gingivitis -Grade III/VI heart murmur -Senior pet -Hyporexia Prognosis: Fair to guarded Plan: -Continue simbadol 0.24 mg/kg PO q24h until 1/29 -Start medical feedings q12h x 5d until 2/1 -Start mirtazapine topically to pinna q24h x 5d until 2/1 -Patient is intolerant of restraint but enjoys petting--start more intensive supportive care if appetite does not improve within 24h

1/28/2022

History: 1/20/22 os intake, RTS (previously at BACC 11/9): underweight, dehydration, heart murmur, dental disease, oral mass, suspected CKD; sedated due to behavior, bw and rads performed, low USG noted; SQF given once 1/21: azotemia noted on bw; started renal diet and SQF 1/26: Poor appetite noted, started simbadol and gave convenia Today, 1/27: progress exam Subjective: BAR. No csvd. Did not touch renal diet, but ate other wet food. Very nervous, will flee. Visual exam only to reduce FAS Eyes: Grossly appropriate OU. Ears: Unremarkable AU. Nasal Cavity: No nasal discharge. Lungs: Eupneic Musculoskeletal: Ambulatory x 4 with no appreciable lameness. BCS = 3-4/9 Integument: roughened haircoat Neuro: Appropriate mentation. Assessment: Chronic kidney disease Underweight Dental disease - severe with mobile/infected right max pm and associated stomatitis/gingivitis Grade III/VI heart murmur Hyporexia Prognosis: Fair to guarded Plan: Continue simbadol 0.24 mg/kg PO q24h until 1/29 Continue medical feedings q12h x 5d until 2/1 Continue mirtazapine topically to pinna q24h x 5d until 2/1

1/29/2022

History: 1/20/22 os intake, RTS, underweight, dehydration, heart murmur, dental disease, oral mass, CKD; BW and 3 view rads performed (old age changes) 1/21: started renal diet and SQF 1/26: Poor appetite noted, started simbadol and gave convenia S) QAR. 5% dehydrated. No c/s/v/d. Eating little. Ur in cage, no BM. Seeks attention and head butts, very affectionate. But backs away and escalates quickly when trying to pick her up. Sedated for full exam prior to rescue and to do SQF -dexdomitor 0.05 cc + torb 0.05 cc. O) EENT: Eyes clr, ears cln, no oculonasal discharges noted. Oral - mass R maxilla - less red and inflamed since convenia given, still marked dental dz of 107, 108 and 109 PLN: no lymphadenopathy CV: Grade II/VI heart murmur, NSR, L: Eupneic, no crackles/wheezes GI: Soft, no pain or masses MSI: Ambulatory x4, moderate diffuse muscle wasting. Rough full HC, no masses noted. NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. A) -Chronic kidney disease -Underweight -Dental disease - severe with mobile/infected right max pm and associated stomatitis/gingivitis -Grade 2-3/6 heart murmur -Senior pet -Hyporexia Prognosis: Fair to guarded P) 1. Sedated exam 2. Extracted diseased teeth 107, 108, 109 - easily removed. Flushed out purulent debris. Photos uploaded. 3. Repeat chest xrays lat and v/d - no changes from previous, NSF. 4. SQF 75 cc given. CWPT Going to rescue. Recom monitor mass for possible resolution after extractions. Dental re-exam to assess need for further dental treatments. +/- FNA/ bx of mass if not resolving. CRD - recom kidney diet and monitoring Heart murmur is mild- mod and stable with no clinical signs. Re-assess need for cardio consult.

1/30/2022

Dental extractions done

Upon intake, Missy allowed staff to lift her out of the carrier she arrived in and place her into a shelter carrier. She was relaxed and allowed petting of her head. Missy was offered wet food which she ate and lured out of the carrier with the food. She allowed collaring, scanning and photographing. She was taken to Vet Services.