9/29/2026

[DVM Intake] DVM Intake Exam Estimated age: 5m based on weight Microchip noted on Intake? scans negative History: Presented at 6pm with possible urinary blockage; history unclear but reported to have had a possible urinary blockage recently and was unblocked by a vet. Now is reported to be dribbling hematuria Subjective: BAR, very active Observed Behavior - squirmy but tolerated all tasks and handling Is there evidence of suspected cruelty? no Objective: P = WNL R = WNL BCS 4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: deciduous dentition PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI, bladder small but feels very thickened- easily expressed small amount of cloudy urine with hematuria MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: externally normal Wood's Lamp Exam: not performed Assessment: Approx. 5m MI DSH Hx of hematuria, stranguria (r/o congenital given age vs idiopathic cystitis vs UTI vs urinary blockage (stones vs cystitis vs other)) Thickened bladder on palpation Prognosis: guarded Plan: in-house cbc/chem (x) unremarkable aside from mild mature neutrophilia lateral radiograph (x) bladder small, no obvious stones seen focal bladder ultrasound - very thickened bladder wall with small lumen SQ fluids (20ml/kg) given on intake Buprenorphine 0.015mg/kg given IM on intakes Intake tasks Gabapentin 15mg/kg PO BID x 10 days for pain Placed in ICU with nosorb in litterbox Priority recheck tomorrow; attempt to collect UA for submission and monitor for stranguria +/- consider add on onsior if clinical signs persist + seek placement asap as may need more advanced imaging/diagnostics to determine the etiology of his condition SURGERY: Temporary waiver due to illness

9/30/2026

DVM Progress Exam S/O: -BAR; eating some food. -Persistent hematuria noted. -Repeat focal bladder ultrasound: bladder remains severely abnormal with markedly thickened bladder wall and very small lumen. -No evidence of complete urinary obstruction at this time. A: -Severe lower urinary tract/bladder disease with persistent hematuria and marked bladder wall thickening. -R/o severe cystitis (infectious vs idiopathic) vs congenital/developmental urinary tract abnormality vs other. -Hx possible recent urinary obstruction/unblocking prior to intake; history unclear. -No obvious uroliths on prior radiographs. -Guarded prognosis given severity of bladder changes, persistent clinical signs and young age. P: -Clavamox 0.5 mL PO BID x7 days; first dose given. -Onsior 0.21 mL SQ SID x3 days; first dose given. -Zorbium applied topically once for analgesia. -Continue Gabapentin as previously prescribed. -Continue close monitoring of urine production, hematuria, stranguria, appetite and overall clinical status. -DVM recheck daily to assess response to treatment. -No placement at this time while assessing response to medical management. -Given severity of bladder disease, anticipate determining whether there is sufficient clinical improvement to continue treatment vs proceed with EHR no later than 5 days from today. -Recheck immediately for inability to urinate, worsening stranguria, pain or other clinical decline. SURGERY: Temporary waiver due to active urinary disease.

10/1/2026

In-House UA - Free Catch Mid Stream via Bladder Expression Color Brown-Red, visibly blood-tinged Appearance Cloudy SG 1.035 BILI Norm, UBG 8, KET Trace, Prot 100(2+), NIT Neg, GLU 15(1+), pH 6, LEU 70(1+), ASC ACID Norm -Overall findings consistent with significant lower urinary tract inflammation/hematuria. -UTI cannot be confirmed or excluded.

10/1/2026

DVM Progress Exam S/O: -BAR, E/D well, using litterbox, urinating without assistance. -No C/S/V/D observed. -No obvious stranguria or inability to urinate noted today. A: -Severe cystitis/bladder disease with hematuria. -Clinically stable today; monitoring response to treatment. -Prognosis remains guarded. P: -Continue current treatments. -Brief DVM recheck tomorrow to ensure continued urination. -Reassess 10/3 with repeat bladder U/S +/- cystocentesis for send-out UA if feasible and clinically appropriate. -If responding favorably with improvement in bladder disease, continue treatment and seek placement; if significant bladder disease persists without adequate improvement, consider EHR.

10/2/2026

Brief recheck S/O: BAR, allows petting but resists restraint for exam; no c/s/v/d noted, good appetite, water dish spilled so difficult to determine water vs urine - but bedding is wet with pink tinge so suspect hematuria EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: Small and irregularly firm UB palpated MSI: Amb x 4 CNS: Appropriate mentation A: Severe cystitis/bladder disease with hematuria - etiology open Prognosis: Guarded long-term P: Continue current treatment plan and recheck as scheduled

10/3/2026

DVM Progress Exam S/O: -BAR, E/D well. -Urinating routinely in litterbox. -Appears visibly comfortable/WNL; no obvious hematuria noted today. -Recheck focal bladder U/S moderately improved compared with prior: lumen now open, with subjectively decreased intraluminal tissue/material and subjectively decreased bladder wall thickening. Previously bladder was markedly thickened with a very small lumen and persistent hematuria. Images in VetDocs. A: -Severe cystitis/bladder disease with hematuria - clinically improving. -Bladder U/S moderately improved with more open lumen and decreased wall thickening/intraluminal tissue. -Prognosis improved given favorable response to treatment, but underlying etiology remains unclear. P: -Continue current treatment plan. -Extend Onsior x4 additional days; total 7 days. -Recheck bladder U/S 10/6 +/- cystocentesis for send-out UA. -Continue monitoring urination, hematuria, appetite and overall clinical status. -Seek New Hope placement ASAP for continued care and further diagnostics as indicated.

10/7/2026

Recheck S/O: BAR, eating well, urine in litterbox (no obvious hematuria), no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: Tense, small moderately firm UB palpated MSI: Amb x 4, healthy haircoat CNS: Appropriate mentation Focal bladder u/s - thickening of bladder wall appreciated, intraluminal masses present - do not seem to be moveable -Urine sample collected via cysto - grossly no hematuria noted A: Hematuria - resolved Cystitis, masses within urinary bladder - ro polyps vs blood clots vs neoplasia Prognosis: Guarded long term P: Submit urine for UA Seek placement for advanced imaging, additional diagnostics, biopsy/sx, etc. Continue clavamox and gabapentin CTM closely on rounds

10/8/2026

Brief recheck, UA results S/O: BAR at front, eating well, no c/s/v/d noted, urine in LB without obvious hematuria EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: Small, moderately firm UB MSI: Amb x 4, healthy haircoat CNS: Appropriate mentation UA: protein 2+ (H), blood/hemoglobin 3+ (H), WBCs 50-75 (H), RBCs 50-75 (H); occasional struvite crystal A: Abnormal urinary bladder - small and firm Masses within UB - ro polyps vs blood clots vs neoplasia Proteinuria, hematuria, pyuria P: Extend/continue gabapentin Seek placement through ARL for additional diagnostics, recommend EHR if placement not found. Patient has hx of urinary blockage, unable to diagnose or treat disease in shelter, risk of UO. CTM closely on rounds

Upon intake Jack was not handled by counselors due to being rushed back to medical as potentially blocked.