1/29/2018

DVM Intake Exam Estimated age: approx 12 years Microchip noted on Intake?neg Microchip Number (If Applicable): History :stray cat found and kept for 24 hours; finder stated that he had bloody diarrhea and no appetite; also has trouble walking on hindlimbs Subjective:BAR Observed Behavior -friendly and affectionate, allows handling Evidence of Cruelty seen -n Evidence of Trauma seen -n Objective BCS 6/9, muscle wasting EENT: OU-mature cataracts, intermittent menace -mild crusting at nares, no sneezing or coughing -AU: clean Oral Exam:mm pigmented, tacky; moderate to severe tartar/staining PLN: No enlargements noted H/L: eupnic, clear lung sounds; gallop arrhythmia ABD: soft, nonpainful, doughy; no palpable abnormalities U/G: male neutered MSI/CNS: -moderate ambulatory paraparesis/plantigrade stance; decreased CP and withdrawal in hindlimbs -mild chronic irritation of paw pads on hind limbs -diffuse moderate to severe muscle wasting -moderate matting, dandruff along dorsum CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: grossly normal Assessment 1. Diabetes mellitus 2. h/o inappetance/bloody diarrhea-r/o secondary pancreatitis vs DKA 3. Geriatric 4. Dental disease 5. Plantigrade stance-suspect diabetic neuropathy Prognosis:guarded to fair Plan: -CBC/chem/T4 -place IVC, start normosol at 15 ml/hr -metronidazole 1 ml PO SID x 7 days -prozinc insulin 1 U SQ BID -convenia inj 0.45 ml SQ -urinalysis to r/o ketoacidosis, concurrent UTI -recheck BG prior to insulin in 3 days -cerenia 0.4 ml SQ IV x 3 days -fortiflora SID x 5 days SURGERY:neutered

1/29/2018

CBC-mild, nonregenerative anemia (28.3%) Chemistry-severe hyperglycemia (470), low ALT (<10), mild hypercholesterolemia A 1. Hyperglycemia consistent with diabetes mellitus 2. Anemia, mild-r/o secondary to DM vs other 3. Low ALT-r/o anorexia vs other P -rec'd urinalysis -start insulin therapy

1/30/2018

S/0: BAR, playful, ate food, hydrated. Mucous membranes pink plus tachy. Resp: WNL BG: A: Plan: Evaluate urinalysis results

1/30/2018

S/O: Ate all his food in the kennel. BAR. Drank 3/4 of waterbowl. Urinalysis results reveled +4 glucose in the urine BG: 298 Assessment: Diabetes Mellitus Plan: Continue on current tx plan Recommend that Jude undergoes a glucose curve in one month to determine the efficacy of the dose of insulin being given. Jude should be also kept permanently on a diabetic food.

1/31/2018

Diabetic, diarrhea, started on IVF, prozinc insulin 1 U BID S/O -BAR, interactive and affectionate -good appetite -episode of dark diarrhea with frank blodo -large urination in box -mm lgt pk/pigmented, moist -no nasal discharge or sneezing -OU: open and clear, cataracts, geriatric changes -eupnic, no murmurs/arrhythmias -soft abdomen, intestines feel sl fluid filled -diabetic neuropathy in hindlimbs A 1. Diabetes mellitus 2. Diarrhea-r/o secondary pancreatitis vs chronic GI vs other 3. Diabetic neuropathy P -Decrease IVF to 7 ml/hr -increase metronidazole to BID dosing -add fortiflora SID

2/1/2018

S/O -BAR, interactive and very affectionate, sweet boy! -mm pigmented, sl tacky -good appetite -formed stool in cage today! frank blood still present but significantly improved -no nasal discharge or sneezing -OU: open and clear -eupnic, purring on auscultation -soft abdomen -diabetic neuropathy in hindlimbs appears improved today! A 1. Diabetes mellitus 2. Diarrhea-improved today! 3. Cataracts 4. Diabetic neuropathy P -CWCT -recommend 6 hr post insulin BG test tomorrow

2/2/2018

S/O: BAR, affectionate, eating and drinking Still on maintenance fluid rate - hydration status good BG - 344 Assessment: Moderate hyperglycemia Consider Increasing insulin dose and conducting glucose curve

2/3/2018

Recheck in medical for DM on insulin tx: S/O - BAR mildly dehydrated - no c/s no v/d observed/reported - urine in litter, small amount of solid feces too (no blood observed) - OU cataracts - h/l nsf - amb x 4 with diabetic neuropathy in hindlimbs (mildly ataxic/weakness, muscle loss, plantigrade stance) - snp - doughy abdomen; gen. dry seborrhea, unkempt coat A: stable condition -> Diabetes mellitus with peripheral neuropathy, cataracts P: CWCT + will recheck BG this afternoon

2/3/2018

BG: 280/s this afternoon - tomorrow is last day of insulin rec' tx reassess and amend dose - straining to defecate this afternoon; firm feces with blood around P: 150 ml LRS SQ EOD x 3 dose

2/3/2018

QAR - this afternoon - semi-solid/diarrhea with hematochezia persists - cont. to monitor and reassess tx in AM

2/4/2018

Fasting BG: 364 S/O -BAR, very friendly and interactive -mm lgt pk/pigmented, sl tacky -noted to have firm stool and then soft stool with blood yesterday, no bowel movement present in cage -no nasal discharge or sneezing -OU: open and clear, cataracts -eupnic, purring softly on auscultation -soft abdomen -diabetic neuropathy but appears stronger in hindlimbs than previous exams -unthrifty hair coat, dandruff over dorsum but subjectively appears improved A 1. Diabetes mellitus 2. Diarrhea-improving slowly 3. Diabetic neuropathy A -continue insulin 1 U BID with meal feeding (ideally with canned, diabetic diet) -recommend recheck fasting BG +/- BG curve in 7 days -extend metronidazole BID x 5 days

2/5/2018

S/O -BAR, very friendly and affectionate, allows all handling -good appetite -no bowel movement noted in box -no nasal discharge or sneezing -OU: open and clear, cataracts, iris atrophy -eupnic, purring loudly on auscultation -soft abdomen, no palpable abnormalities -diabetic neuropathy in hind limbs, improving A 1. Diabetes mellitus 2. Geriatric, overall health appears improved P -HC, okay for transport -recommend BG curve in 7 days

Upon intake, Jude was slow blinking and meowing softly. Jude was head butting and soliciting attention. Jude lifted his rear when he was petted and appreciated the petting. Jude allowed all handling.