8/9/2019

DVM Intake Exam Estimated age: 6y Microchip noted on Intake? no History : Stray Subjective: BAR, hissing in carrier. No c/s/v/d. mod skin tenting, no noted appetite, no elimination noted Observed Behavior -Nervous, hissing in carrier, toweled for exam and tolerated handling. Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective T = 99.8 P = WNL R = WNL BCS 5/9 EENT: No ocular/nasal discharge. Ears clear of debris/cerumen. Alopecia noted on ear pinna AU Oral Exam: Mild to moderate dental plaque/tartar, mild gingival inflammation. Stage 2 dental disease. MM pale pink, tachy mm CRT 3s, skin tent appreciated. Aprox 7-10% dehydrated PLN: No enlargements noted H/L: No murmurs or arrythmias appreciated. Normal BV sounds, no crackles or wheezes ABD: Pendulous abdomen, painful on palpation U/G: FI, moderate to severe malodorous mucopurulent vulvar discharge MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: visually normal Assessment: Pyometra - open Dehydrated Stage II dental disease Alopecia (woods lamp -) Prognosis: Gaurded pending surgery results Plan: Move to medical OHE ASAP CBC/Chem Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture IVC at 2x maintenance Cerenia 1mg/kg IV SID x 5 days Baytril 10mg/kg IM SID x 14 days SURGERY: Okay for surgery

8/10/2019

H: Intake 8/9. Noted to have open pyometra. Started on enrofloxacin, maropitant and IVF. Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture S: BAR. ~5% dehydrated. No csvd. Active purulent vaginal discharge. Eating well Eyes: Grossly appropriate OU. Ears: Unremarkable AU. Nasal Cavity: No nasal discharge. Heart: Grade I-II heart murmur ausculted. Lungs: Eupneic, lungs clear. No crackles or wheezes bilaterally. Abd: Tenses on abdominal palpation. U/G: FI, no MGT palpated, severe purulent vaginal discharge noted Musculoskeletal: Ambulatory x 4 with no appreciable lameness. BCS = 6/9 Integument: roughened haircoat Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) Chem: Mild hyperglobulinemia (5.8) Assessment: Pyometra - open Dehydrated Stage II dental disease Alopecia Heart Murmur Prognosis: Gaurded pending surgery results Plan: OHE ASAP- unable to perform today as patient was given food, wont be able to perform until Monday (unless pulled by NH) Cerenia 1mg/kg IV SID until 8/13 Baytril 10mg/kg IM SID until 8/23 Start Simbadol 0.24 mg/kg SQ SID until 8/17 IVF @ 15ml/hr

8/11/2019

H: Intake 8/9. Noted to have open pyometra. Started on enrofloxacin, maropitant and IVF. Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10. Surgery not done due to not being NPO CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) Chem: Mild hyperglobulinemia (5.8) SO: BARH. No csvd. Active purulent vaginal discharge. Good appetite. Will hiss when approached, needed handling. EENT: eyes clear, ears clean, no discharge or congestion noted on exam Oral: unremarkable adult dentition H/L: Eupneic, no irregular beats, normal lung sounds. Grade 2 HM present MSI: ambulatory, unremarkable palpation, coat roughened and unkempt Abd: palp unremarkable Neuro: A&A Female intact, active purulent discharge A: Pyometra - open Dehydrated - resolved Stage II dental disease Heart Murmur Prog: Guarded pending surgery results P: OHE ASAP - unable to do today due to staffing Cerenia 1mg/kg IV SID until 8/13 Baytril 10mg/kg IM SID until 8/23 Simbadol 0.24 mg/kg SQ SID until 8/17 IVF @ 15ml/hr

8/12/2019

History 8/9/19 intake: open pyometra, started on enrofloxacin, maropitant and IVF. -Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10: Surgery not done due to not being NPO -CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) -Chem: Mild hyperglobulinemia (5.8) S/O: BAR, hissing and growling, full exam under sedation. EENT: Eyes clear, ears clean, no nasal discharge noted H/L: Grade I HM, SSP; Lungs clear, eupnic MSI: Ambulatory x 4, healthy hair coat, caudally wet and malodorous CNS: Mentation appropriate A: Open pyometra Heart murmur Stage II dental disease P: OHE today Continue with current treatment plan SURGERY: Okay for surgery

8/12/2019

Feline OVH - Pyometra Ventral Midline Incision -Uterus distended with fluid in lobular pattern, severe fluid distention at proximal right uterine horn. Multiple ovarian cysts present bilaterally. Ovaries Ligated with: Pedicle ties Uterine Body Ligated with: 3-0 PDS miller's and surgeon's knots Abdominal Closure: 3-0 PDS simple continuous Subcutaneous Closure: 3-0 PDS simple continuous Skin Closure: 3-0 PDS intradermal, skin glue Green Linear Tattoo Placed Surgeon: 1438 Additional Comments: -Incised uterus post op - purulent liquid -Smooth recovery -Onsior 2 mg/kg SQ SID until 8/14

8/13/2019

History 8/9/19 intake: open pyometra, started on enrofloxacin, maropitant, simbadol, and IVF. Also noted dental disease, alopecia, dehydration. -Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10: Surgery not done due to not being NPO, heart murmur noted -CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) -Chem: Mild hyperglobulinemia (5.8) 8/12: OHE performed (uterus notably irregular and distended with purulent fluid). Onsior post op. S/O: 1 day post op OHE for pyometra. BARH, hissing and growling, exam performed with towel restraint. Eating well, no v/d noted. EENT: Eyes clear, ears clean, no nasal discharge noted Oral Exam: mm pink H/L: NMA, SSP; Lungs clear, eupnic U/G: Spay site CDI, approp healing MSI: Ambulatory x 4, healthy hair coat, BCS 5/9 CNS: Mentation appropriate A: Post op pyometra Heart murmur - did not appreciate on auscultation today Dental disease P: Removed IV catheter Continue simbadol 0.24 mg/kg SQ SID until 8/17 Continue enrofloxacin 5 mg/kg IM SID until 8/23 Continue onsior 2 mg/kg SQ SID until 8/14 Start gabapentin 20 mg/kg PO BID indefinitely for shelter anxiety

8/14/2019

History 8/9/19 intake: open pyometra, started on enrofloxacin, maropitant, simbadol, and IVF. Also noted dental disease, alopecia, dehydration. -Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10: Surgery not done due to not being NPO, heart murmur noted -CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) -Chem: Mild hyperglobulinemia (5.8) 8/12: OHE performed (uterus notably irregular and distended with purulent fluid). Onsior post op. 8/13-8/14: deceased kitten in same room had positive parvo snap test. Great Victoria received her FVRCP vaccine on 8/13. S/O: BAR, hissing and growling, visual exam performed. Eating well, no v/d noted. EENT: Eyes clear, ears clean, no nasal discharge noted Lungs: eupneic, normal rate and effort MSI: Ambulatory x 4, healthy hair coat CNS: Mentation appropriate A: Post op pyometra Hx heart murmur Dental disease Possible panleuk exposure P: Continue simbadol 0.24 mg/kg SQ SID until 8/17 Continue enrofloxacin 5 mg/kg IM SID until 8/23 Continue gabapentin 20 mg/kg PO BID indefinitely Panleukopenia titers sent to Idexx Quarantine due to high risk

8/15/2019

History 8/9/19 intake: open pyometra, started on enrofloxacin, maropitant, simbadol, and IVF. Also noted dental disease, alopecia, dehydration. -Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10: Surgery not done due to not being NPO, heart murmur noted -CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) -Chem: Mild hyperglobulinemia (5.8) 8/12: OHE performed (uterus notably irregular and distended with purulent fluid). Onsior post op. 8/13-8/14: deceased kitten in same room had positive parvo snap test. Great Victoria received her FVRCP vaccine on 8/13. S/O: BARH, e/d well. No c/s/v/d. Hissing and growling when approached in kennel. Visual exam performed due to P temperament. EENT: No ocular/nasal discharge noted. Ears clear of debris/cerumen. Lungs: eupneic, normal rate and effort MSI: Ambulatory x 4, healthy hair coat CNS: Mentation appropriate A: Post op pyometra Hx heart murmur Dental disease Possible panleuk exposure P: Continue simbadol 0.24 mg/kg SQ SID until 8/17 Continue enrofloxacin 5 mg/kg IM SID until 8/23 Continue gabapentin 20 mg/kg PO BID indefinitely Panleukopenia titers sent to Idexx Quarantine due to high risk

8/16/2019

History 8/9/19 intake: open pyometra, started on enrofloxacin, maropitant, simbadol, and IVF. Also noted dental disease, alopecia, dehydration. -Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10: Surgery not done due to not being NPO, heart murmur noted -CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) -Chem: Mild hyperglobulinemia (5.8) 8/12: OHE performed (uterus notably irregular and distended with purulent fluid). Onsior post op. 8/13-8/14: deceased kitten in same room had positive parvo snap test. Great Victoria received her FVRCP vaccine on 8/13. S/O: BARH, e/d well. No c/s/v/d. Urine noted in litter box, no stool. Hiding in back corner of kennel, immediately starts hissing and growling when approached. Visual exam performed due to P temperament. EENT: No ocular/nasal discharge noted. Ears clear of debris/cerumen. Lungs: eupneic, normal rate and effort MSI: Ambulatory x 4, healthy hair coat CNS: Mentation appropriate A: Post op pyometra Hx heart murmur Dental disease Possible panleuk exposure P: Continue simbadol 0.24 mg/kg SQ SID until 8/17 Continue enrofloxacin 5 mg/kg IM SID until 8/23 Continue gabapentin 20 mg/kg PO BID indefinitely Panleukopenia titers sent to Idexx Quarantine due to high risk

8/17/2019

History 8/9/19 intake: open pyometra, started on enrofloxacin, maropitant, simbadol, and IVF. Also noted dental disease, alopecia, dehydration. -Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10: Surgery not done due to not being NPO, heart murmur noted -CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) -Chem: Mild hyperglobulinemia (5.8) 8/12: OHE performed (uterus notably irregular and distended with purulent fluid). Onsior post op. 8/13-8/14: deceased kitten in same room had positive parvo snap test. Great Victoria received her FVRCP vaccine on 8/13. S: BAR. No csvd. Eating well. Limited exam due to temperament Eyes: Grossly appropriate OU. Ears: Unremarkable AU. Nasal Cavity: No nasal discharge. Lungs: Eupneic U/G: FS. No discharge. Musculoskeletal: Ambulatory x 4 with no appreciable lameness. Integument: Otherwise unremarkable haircoat. Neuro: Appropriate mentation. Rectal: Not performed. Externally normal. A: Post op pyometra Hx heart murmur Dental disease Possible panleuk exposure P: ok to d/c simbadol Continue enrofloxacin 5 mg/kg IM SID until 8/23 Continue gabapentin 20 mg/kg PO BID indefinitely Panleukopenia titers sent to Idexx Quarantine due to high risk- last day 8/27

8/18/2019

Progress exam-post op pyometra/panleukopenia quarantine History : Intake 8/9/19-pyometra, dehydrated, dental disease, alopecia. Started on IVF, baytril, cerenia Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10-started on simbadol CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) Chem: Mild hyperglobulinemia (5.8) 8/12-spayed, smooth surgery and recovery 8/13-started on gabapentin for shelter anxiety 8/14-exposed to panleukopenia. High risk due to recent vaccines. Titers sent to UW. Subjective: BAR. Cage exam only-patient is stable, doing well, and no signs of panleukopenia. Eating some but is also very nervous in the cage. Placed cage cover but she pulled it off into the cage. Normal BM and U. Recommend full exam when quarantine is released or if her status changes. Objective EENT: Eyes clear, no nasal or ocular discharge noted H/L: Normal RR/RE, eupneic MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Post op pyometra Panleukopenia quarantine until 8/27 or when titers return Hx heart murmur Dental disease Prognosis: Good Plan: CTM while at BACC Quarantine in place due to high risk (recent vaccines)-last day 8/27 or when titers return Continue baytril 5mg/kg IM SID until 8/23 Continue gabapentin 20mg/kg PO BID Rec dental with placement

8/19/2019

Progress exam-post op pyometra/panleukopenia quarantine History : Intake 8/9/19-pyometra, dehydrated, dental disease, alopecia. Started on IVF, baytril, cerenia Abd Rads- abdomen filled with soft tissue opacity in large tubular form. Suspect pyometra with no evidence of rupture 8/10-started on simbadol CBC: Mildly regenerative, mild anemia (Hct 28.4, retic 63.9), moderate leukocytosis (39.13), moderate neutrophilia (25.63), severe lymphocytosis (though these may be band neutrophils) (10.89), monocytosis (1.57) Chem: Mild hyperglobulinemia (5.8) 8/12-spayed, smooth surgery and recovery 8/13-started on gabapentin for shelter anxiety 8/14-exposed to panleukopenia. High risk due to recent vaccines. Titers sent to UW. Subjective: BAR. No csvd. Great appetite. Stable and doing well. Objective EENT: Eyes clear, no nasal or ocular discharge noted H/L: Normal RR/RE, eupneic MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Post op pyometra Panleukopenia quarantine until 8/27 or when titers return Hx heart murmur Dental disease Prognosis: Good Plan: CTM while at BACC Quarantine in place due to high risk-last day 8/27 or when titers return Continue baytril 5mg/kg PO SID until 8/23 (switched from IM due to great appetite) Continue gabapentin 20mg/kg PO BID Rec dental with placement Recommend full exam when quarantine is released or if her status changes.

8/20/2019

Titer result 1:160 Interpretation-appropriate immune response to vaccine, ok to remove from quarantine

upon intake no handling was done by counselor. Counselor was unable to collar. She was hissing and she was rush to medical.