7/7/2026

Cardiopet proBNP: 851 (N)

7/7/2026

CBC: 35.1 (L) CHEM: Total protein 9.3 (H), globulin 6.8 (H) T4: wnl Interpretation: -Mild anemia - ro pre-regenerative vs non-regenerative -Hyperproteinemia, hyperglobulinemia - ro inflammation vs other

7/7/2026

BAR in kennel, no c/s/v/d noted, eupneic, appropriate mentation; paws visibly swollen/erythematous x 4. PLAN: Intake exam/tasks ASAP

7/10/2026

[DVM Intake] DVM Intake Exam Estimated age: 5yrs based on dentition/conformation Microchip noted on intake? scans negative History: Owner surrender due to 6-7 month history of severe inflammation of paw pads. Former owner was unable to seek veterinary care. No diagnostics or treatments performed thus far. On initial presentation on 7/6, there was a concern for a collapse episode- full bloodwork and a proBNP were performed at that time Subjective: BAR Observed Behavior - high-energy, panting and jumping up, not interested in food, mouthy at times, very squirmy for restraint, sedated for exam and tasks Is there evidence of suspected cruelty? no Objective: P = 130 (prior to sedation) R = panting, eupneic BCS 4/9 EENT: Eyes clear, ears thick crusty debris AU and malodorous, no nasal or ocular discharge noted, abrasion on bridge of nose Oral Exam: adult dentition, worn with thick tartar on molars PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FI; no vulvar dc or MGTs MSI: Ambulatory x 4, skin free of parasites, all 4 paws have severely swollen paw pads with digital pads fused together and areas of moist erythema, bleeding and crusting, mostly healthy hair coat with focal areas of alopecia around carpi and tarsi CNS: Mentation appropriate - normal motor and cp's x 4, occasionally seems off-balance and trips/falls over, no other signs of neurologic abnormalities Rectal: externally normal Wood's Lamp Exam: not performed Assessment: Approx. 5yr FI canine Otitis externa Severe inflammation of all 4 paws and paw pads with fused digital pads, areas of moist erythema between remaining pads, crusting and bleeding (r/o inflammatory/allergy/atopy with severe pododermatitis vs other autoimmune vs neoplasia) Prognosis: fair pending diagnostics and response to treatment Plan: sedated with dexdomitor 10mcg/kg + torb 0.2mg/mg IM and achieved deep sedation Ear cleaning and apply simplera AU intake tasks punch biopsies taken from left hind paw pads in 2 areas representative of lesions Dilute chlorhex foot soaks and then applied duoxo-chlorhex mousse between paw pads Reviewed labwork from 7/6: mild non-regenerative anemia, normao ProBNP, hyperproteinemia with hyperglobulinemia (r/o inflammation vs neoplasia) Start gabapentin 20mg/kg PO BID indefinitely for pain/pruritis related to paw pads (300mg) Start trazadone 7mg/kg PO BID indefinitely (125mg) Pending biopsy results, consider starting anti-inflammatory dose of steroids (rec wait 3-5 days for punch biopsy sites to heal) Reversed with equal volume antesedan and recovery was uneventful Will likely have chronic condition related to paw pads requiring ongoing treatment and veterinary care DVM recheck in 24 hours then to review biopsy results in 3 days SURGERY: Temporary waiver due to comorbidities

7/10/2026

[Spay/Neuter Waiver - Temporary] Your newly adopted pet has been diagnosed with comorbidities, 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.

7/11/2026

Recheck severe chronic pododermatitis suspected, biopsies pending S/O: BAR, active, allows all handling, great appetite, no c/s/v/d noted EENT: No ocular or nasal discharge, kennel nose secondary to rubbing LUNGS: Eupneic MSI: Ambulatory x 4; severe and chronic changes to paws x 4 - almost all digital paw pads very abnormal and fused together - tissue is soft and not thick/calloused like normal paw pads; varying degrees of erythema, deep crevices have mild debris/discharge deep within, interdigital cysts CNS: Appropriate mentation A: Severe, chronic pododermatitis Severe chronic changes to paws and paw pads Otitis Rule out underlying allergy vs other autoimmune vs open P: Wiped down palmar/plantar aspects of paws and into crevices as much as she would allow, tried to remove debris/discharge Biopsy pending Continue gabapentin and trazodone Unlikely to be an issue that will resolve in shelter. Patient would ideally see specialist for long-term management/treatment plan (rec dermatologist). CTM closely while at QACC

7/16/2026

Brief recheck, biopsy pending S/O: BAR, good appetite, no c/s/v noted, diarrhea FS 6 in kennel EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 with no notable lameness, erythema improving on all 4 paws, swelling still severe with chronic changes to paw pads A/P: Severe, chronic pododermatitis; otitis; diarrhea x 1; CTM, pend biopsy for treatment plan.

7/17/2026

Biopsy results: Biopsy Type: SKIN_PUNCH Pathology Report INTERPRETATION: Mild to moderate chronic lymphoplasmacytic, mastocytic, minimal neutrophilic perivascular to periadnexal dermatitis, hydroadenitis, sebaceous hyperplasia, epidermal hyperplasia THIS BIOPSY REPORT HAS BEEN COMPLETED BY A MEMBER OF THE DERMATOPATHOLOGY TEAM, AS REQUESTED. PRELIMINARY REPORT, RECUTS PENDING, ADDENDUM TO FOLLOW COMMENTS: In the initial sections examined there is a mixed inflammatory dermatitis with some hyperplastic and reactive changes. Neither sample has evidence of a neoplastic process, autoimmune disorder, or specific infectious agent. There is some inflammation of apocrine glands including neutrophilic infiltrates of the glandular lumen which may indicate pyoderma. I have asked for deeper sections of the tissue block to better evaluate the epidermis and superficial dermis of one of the biopsies. These results and additional comment will be reported in an addendum as soon as possible. HISTOPATHOLOGIC DESCRIPTION: Two biopsies are submitted. Both samples contain pilosebaceous units. One has epidermal hyperplasia and hyperkeratosis and I suspect is at the paw pad junction. The dermis contains perivascular to periadnexal inflammatory cells in small to moderate numbers. Most inflammatory cells consist of plasma cells and small lymphocytes. Fewer macrophages, mast cells, and occasional neutrophils are seen. Apocrine glands are infiltrated by more prominent neutrophilic inflammation and few eosinophils mixed with plasma cells and small lymphocytes. Some macrophages have intracytoplasmic light brown pigment. There is moderate sebaceous hyperplasia. No atypical cells are identified.

7/17/2026

Recheck -Biopsy results consistent with an inflammatory process with some hyperplastic and reactive changes. No evidence of neoplasic process, autoimmune disorder, or specific infectious agent. *Addendum to follow, request for deeper sections. S/O: BAR, active, eating well, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 with no notable lameness, paws x 4 have improved erythema and subjectively improved swelling CNS: Appropriate mentation A: Inflammation, hyperplasia of paws x 4 - ro chronic dermatitis secondary to allergies vs other P: Pend addendum to biopsy results Paws seem to be improving at this time, but consider steroids at anti-inflammatory dose pending biopsy results CTM while at QACC

7/24/2026

ADDENDUM; 7/20/2026 3:45 PM RECUTS/UPDATED COMMENTS: Additional sections of the tissue are evaluated. Both samples are similar with a mild to often moderate inflammatory infiltrate perivascular to adnexal, and largely consisting of lymphocytes and plasma cells indicating a chronic process. The clinical description suggests a severe process, but the specific etiology is difficult to determine based on the biopsies alone. The changes are nonspecific but consistent with a chronic dermatitis, and likely a deep pyoderma is a contributing cause. Sebaceous hyperplasia as seen in this case is frequently identified with this type of lesion. The history indicates there is swelling of the paw pads, but both of these samples contain adnexal structures, and it is unclear whether the paw pads have similar features. When only the feet/paw pads are involved evaluation of the patient's environment in ruling out possible irritants or other triggers may be warranted. Some lesions that only affect the paw pads or may only affect the paw pads such as pemphigus foliaceus, superficial necrolytic dermatitis, or split paw pad disease are not supported by these biopsies or the patient's history. Bacterial culture and sensitivity may be of benefit. Although only small numbers of mast cells are present, and eosinophils are very rare, hypersensitivity/allergic condition may also affect the feet and digits, especially if there is evidence of self-trauma including licking/chewing and rubbing of the feet. Canine atopy frequently affects the digit/interdigital skin.

7/24/2026

Recheck paws, addendum to biopsy results S/O: BAR, active, good appetite, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 without notable lameness; severe swelling of paws x 4 with slightly improved erythema overall, but paws remain significantly abnormal Addendum indicates chronic dermatitis, likely deep pyoderma contributing. A: Severe swelling, chronic changes to paws and paw pads - ro chronic dermatitis, pyoderma vs other P: Start clavamox 13 .75 mg/kg PO BID x 14 days Recheck in one week, consider pred if no improvement

7/28/2026

Progress Exam – CIRDC signs noted on rounds S/O: BAR, eating well, sneezing, no c/v/d noted EENT: Eyes clear, mild serous nasal discharge noted H/L: Eupneic, normal respiratory rate/effort ABD: No obvious distention MSI: Ambulatory x 4, no notable lameness; paws significantly swollen with abnormal pad tissue as previously noted, erythema continues to improve CNS: Mentation appropriate Assessment: CIRDC Chronic pododermatitis Plan: Move to iso Placed monitoring log Already on clavamox - continue this antibiotic and hold on starting doxycycline unless clinical signs not improving Recheck CIRDC day 10 CTM while at QACC

7/31/2026

Recheck paws, currently on Clavamox. Also has CIRDC clinical signs. S/O: BAR, active, good appetite, Coughing noted on exam with mild NDC. LUNGS: Eupneic MSI: Amb x 4 without notable lameness; severe swelling of paws x 4 with slightly improved erythema overall, but inderdigital skin between paw pads remain significantly abnormal A: - Chronic interdigital dermatitis + sebaceous hyperplasia with high potential for deep pyoderma as contributing cause. - CIRDC - moderate P: Patient appears relatively comfortable with interdigital skin abnormalities, with no lameness or pain elicited on palpation. Overall, this is a chronic process that will likely take time for improvement. May need to extend antibiotics, but will see how this progresses once we are able to start prednisone. Continue clavamox 13 .75 mg/kg PO BID until end of course. Recheck scheduled x7 days. Once CIRDC has resolved, consider prednisone course. Held off on starting today as CIRDC was still moderate.

8/6/2026

Recheck CIRDC and paws - currently finishing clavamox. S/O: BAR, active, good appetite, Moderate NDC and ODC noted. No active coughing today. LUNGS: Eupneic MSI: Amb x 4 without notable lameness; moderate swelling of paws x 4 with improved erythema overall, but interdigital skin between paw pads remain significantly hypertrophied. A: - Chronic interdigital dermatitis + sebaceous hyperplasia with high potential for deep pyoderma as contributing cause. - CIRDC - moderate P: Patient appears relatively comfortable with interdigital skin abnormalities, with no lameness or pain elicited on palpation. Overall, this is a chronic process that will likely take time for improvement. - OK to d/c clavamox. - Rx Doxycycline 10mg/kg (200mg) PO SID x 10 days As CIRDC has still not fully resolved, hold on prednisone at this time. OK for next steps, follow-up with primary care veterinarian with placement about any steps for paws long-term. recheck scheduled x 3 days to evaluate CIRDC progress. Determine if can move out of ISO?

8/7/2026

Recheck CIRDC. BAR, no ODC or NDC noted today. Eating all food, normal energy. Productive cough noted on exam. Continue with current plan. Recheck is already scheduled for 8/9, assess if can move out of ISO at that time.

8/9/2026

Brief cageside progress exam S: BARH - at front of kennel soliciting attention pink moist mm at distance no c/v/d reported, spontaneous sneeze great appetite O: EENT: No ocular discharge, mild serous nasal discharge, corneas clear LUNG: Eupneic at distance MSK: Ambulatory x4 INT: Healthy haircoat at distance CNS: Appropriate mentation A/P: Continue doxycycline course as RXd, OK to move to out to ISO instead of med ISO if space Recheck CIRDC day 7 and 10 of tx

8/15/2026

Progress exam: CIRDC day 10 recheck Subjective: BAR, no C/S/V/D. AS:3 empty tray present Objective: EYES: Clear LUNGS: Eupneic, no sign of respiratory distress NASAL CAVITY: no discharge MUSCULOSKELETAL: Ambulatory x4, no lameness or lesions NEURO: Appropriate mentation ASSESSMENT: Presumed CIRDC appears resolved PLAN: Per standing orders -Move out of iso, signage placed -CTM on daily rounds while in QACC

8/19/2026

Recheck paws S/O: BAR, active and wiggly with handling, good appetite, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 with no lameness noted; paws appear overall improved with mild erythema and moderate swelling still present, paw pads remain hyperplastic/abnormal CNS: Appropriate mentation A: Chronic pododermatitis, chronic changes to paw pads P: Start prednisone taper - 1 mg/kg PO SID x 7 days Recheck in one week and consider taper vs extend

8/26/2026

Recheck paws, prednisone started one week ago S/O: BAR, active, good appetite, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 with no notable lameness; paws and paw pads appear similar to previous - moderate interdigital swelling remains, some focal regions of erythema with some interdigital cysts noted; paw pads irregular A: Chronic changes to paws secondary to chronic pododermatitis P: Continue prednisone at current dose Restart clavamox 15 mg/kg PO BID CTM on rounds, recheck paws in one week.

8/28/2026

Staff report pica, eating entire cardboard food dishes. PLAN: Recommend use metal dishes; taper prednisone dose to 0.75 mg/kg SID and recheck as scheduled.

9/2/2026

Recheck paws, staff also report she is pulling so hard on neck lead during walks that she becomes wobbly and almost passes out S/O: BAR, good appetite, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 with no notable lameness; paw x 4 still have mild-moderate interdigital swelling and erythema CNS: Appropriate mentation A: Pododermatitis with chronic changes to paw pads - overall significant improvement since intake, however problem not resolved P: Okay to taper prednisone to 10 mg PO SID (0.5 mg/kg) Continue clavamox PO BID CTM on rounds and recheck in one week Emailed behavior team to request harness placement

9/11/2026

Recheck chronic pododermatitis, clavamox ended two days ago, last dose of pred was also 2 days ago (was on 0.5 mg/kg PO SID) S/O: BAR, good appetite, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 with no notable lameness - interdigital swelling and erythema remains, appears moist today, paw pad tissue also improved but remains significantly abnormal CNS: Appropriate mentation A: Chronic pododermatitis - suspect licking vs exudate appreciated today P: Taper pred to EOD E-collar placed Start chlorhex foot soaks 1-2 times weekly Monitor closely and consider apoquel if licking paws persists Will need follow-up with placement for continued/long-term treatment plan

9/18/2026

Recheck paws and ears; moved out to population recently but has been noted to be limping since returning, observed licking paws; on pred taper and today is last dose (has been on EOD dosing for 1 week) S/O: BAR, active and allows handling, but mouthy when attempting to clean ears. No c/s/v/d noted. EENT: No ocular or nasal discharge, moderate to heavy dark discharge AU MSI: Amb x 4 with weight bearing RFL lameness; paw pad tissue is regrowing but palmar/plantar surfaces of all paws remain swollen and abnormal, significant interdigital swelling +/- erythema appreciated on all 4 paws -RF paw: large purple/red cyst between digits 4-5 with draining tracts on the palmar interdigital surface, moist/greasy residue on palmar surfaces -LF paw: two draining tracts at dorsal aspect of paw between digits 3-4 -RH paw: draining tract at plantar surface between digits 4-5, small - approx 3-5mm -LH paw: wound/draining tract at plantar surface of paw between digits 4-5, approx 1cm A: Otitis externa Chronic pododermatitis - ro flare up from medication adjustment vs moving out to population/husbandry changes Allergies - ro food +/- atopy +/- flea P: Sedated with dex/torb 0.5 ml IM of each Cleaned ears thoroughly and applied simplera AU Soaked paws x 4 in dilute chlorhex Restart clavamox ~16 mg/kg PO BID x 14 days Start proviable PO SID while on clavamox Continue foot soaks Continue gabapentin for FAS + pain Hold off on pred or apoquel due to concern for ongoing deep tissue infection Placed e-collar CTM closely and recheck in 5 days **Raven's pododermatitis will not be resolved in shelter. She needs a home with better husbandry (a clean, soft place) as well as close monitoring, adjustment of medications, and allergy treatments that are not available in shelter. Seek placement ASAP.

Upon intake, Raven was very friendly and social. She had lots of energy and solicited attention. She allowed all handling. Raven taken back to medical and no further handling done.