Animal Profile


Grace

Hello, my name is Grace. My animal id is #61799. I am a female muted calico cat at the . The shelter thinks I am about 2 years 6 months 1 weeks old.

I came into the shelter as a owner surrender on 03-May-2019, with the surrender reason stated as animal health - other.

Reserved

Someone has already placed a deposit on me. I'm no longer available.

Grace was placed at risk due to medical concerns; Grace was diagnosed with a heart murmur, Anemia, URI amount others. obviously, Grace will benefit from placement out of the care center as soon as possible. there are no behavioral concerns for Grace at this moment, she got an Average for her behavior assessment.

My medical notes are...

Weight: 6.1875 lbs

3/05/2019

DVM Intake Exam Estimated age: 3y Microchip noted on Intake? no Microchip Number (If Applicable): History : owner surrender, stated dealing for a long time with skin condition to no effect Subjective: BARH, good appetite, no elimination noted Observed Behavior - allowed handling, escalated to growling and trying to flee Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = wnl BCS 4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: unremarkable adult dentition PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: female intact, no leakage or discharge MSI: Ambulatory x 4, no visible parasites, no masses noted, alopecia on neck and ventrum. area around neck severely excoriated with fresh bloody wounds. the ventrum has multiple miliary papules. Extreme pruritus along the ventral neck CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: visually normal Assessment dermatitis wound Prognosis: fair to good depending on response to treatment Plan: convenia SQ once simbadol 0.24mg/kg SQ SID until 5/5 benedryl 0.5mg/kg PO BID until 5/5 entederm topical BID until 5/5 medicated bath and tech intake tomorrow impression smear - mostly cocci e collar and vest SURGERY: temp waiver dermatitis

4/05/2019

History 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds from pruritis. Impression smear (sample from skin fold in neck) showed TNTC cocci Convenia given. Simbadol, benadryl, topical entederm. E-collar and vest. S/O: Scheduled for medicated bath today. BAR, purring and attention seeking at front of cage, eating and drinking very well, allows some handling but escalates to growling and swatting with moderate restraint. EENT: Eyes - mild dried discharge UO, ears - mild dark discharge AU, no nasal discharge noted Oral Exam: mm pink, CRT <2, mild tartar H/L: No overt murmur - purring and then growling Lungs clear, eupnic ABD: Non painful, no masses palpated MSI: Ambulatory x 4, BCS 4/9, alopecia and severe lichenification and erythema along neck and inguinal region. Pigmentation present inguinally. Ventral neck is moist with thick purulent discharge in skin folds. Secondary/self inflicted excorations-lacerations at lateral and ventral neck extending to sides of face. CNS: Mentation appropriate, no signs of neurologic abnormalities Assessment: Severe pyoderma, dermatitis - ro allergy (atopy vs food vs FBD) vs autoimmune vs other Secondary self inflicted excoriations and lacerations to neck Prognosis: Fair Plan: Sedate for medicated bath today CBC/Chem - machine not working, scheduled for tomorrow Continue simbadol 0.24 mg/kg SQ SID until 5/5 Continue benadryl 1 mg/kg *change to SQ injection* BID until 5/5 Continue topical entederm to neck BID until 5/5 Keep e-collar and shirt on to prevent scratching SURGERY: Temporary waiver due to pyoderma

5/05/2019

Progress exam Intake 5/3/19: Owner surrender. Noted severe dermatitis, pyoderma with secondary self inflicted wounds from pruritis. Impression smear (sample from skin fold in neck) showed TNTC cocci Convenia given. Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4: Received medicated bath Today, 5/5: progress exam Subjective: BARH, no coughing/sneezing/vomiting/diarrhea. Objective: P: WNL R: WNL BCS: 4/9 EENT: Ears and nares clear bilaterally, no discharge noted. Mild dark discharge OU, unchanged from prior exam, no blepharospasm. CV: No murmurs or arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Soft, nonpainful, no palpable masses. Growling when palpated, likely due to handling rather than pain. INT: Alopecia and severe lichenification and erythema along neck, caudal aspect of forelimbs, and inguinal regions. Superficial excoriations and lacerations present at lateral and ventral neck, unchanged from previous exam--no healing noted, appears to be irritated by e-collar placement. No discharge noted in skin folds today, skin on ventrum moist. E-collar and shirt in place. MS: Ambulatory x4, no pain on palpation of epaxials NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Assessment: -Severe pyoderma, dermatitis - ro allergy (atopy vs food vs FBD) vs autoimmune vs other -Secondary self inflicted excoriations and lacerations to neck (not healing) Prognosis: Fair Plan: -CBC/Chem - machine still not working, scheduled for tomorrow 5/6 -Extend simbadol 0.24 mg/kg SQ SID until 5/8 -Start gabapentin 20 mg/kg PO q12h indefinitely -Continue benadryl 1 mg/kg SQ BID until 5/5, then place back on oral benadryl 4 mg/kg PO q12h indefinitely -Continue topical entederm to neck BID until 5/5 -Remove e-collar, keep shirt on to prevent scratching. Consider applying neck bandage while under sedation for bath to prevent further excoriation -Continue medicated baths q72h, next one scheduled for 5/7 SURGERY: Temporary waiver due to pyoderma

5/05/2019

withheld oral benedryl due to inability to give an appropriate oral dose

6/05/2019

History 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds from pruritis. Impression smear (sample from skin fold in neck) showed TNTC cocci Convenia given. Simbadol, benadryl, topical entederm. E-collar and vest. 5/4 Medicated bath (under sedation). Benadryl switched from IM administration to SQ. Scheduled CBC/Chem but machine not working. 5/5 Extended simbadol, start gabapentin. Scheduled CBC/Chem because machine still not working. S/O: BAR, vocal and very seeking at front of cage, eating and drinking very well, allows light handling/cleaning of wounds EENT: Eyes clear, ears - mild dark discharge AU, no nasal discharge noted Oral Exam: mm pink, CRT <2, mild tartar H/L: No overt murmur - purring, Lungs clear, eupnic MSI: Ambulatory x 4, BCS 4/9, alopecia and severe lichenification along neck and inguinal region. Pigmentation present inguinally. Ventral neck is moist in areas with mild thick purulent discharge in skin folds. Erythema improved - resolved. Secondary/self inflicted excorations-lacerations at lateral and ventral neck extending to sides of face. CNS: Mentation appropriate, no signs of neurologic abnormalities Assessment: Severe pyoderma, dermatitis - ro allergy (atopy vs food vs FBD) vs autoimmune vs other Secondary self inflicted excoriations and lacerations to neck Prognosis: Fair Plan: CBC/Chem today Continue simbadol 0.24 mg/kg SQ SID until 5/8 Start cleaning neck with chlorhex BID x 5 days Continue gabapentin 20 mg/kg PO BID indefinitely Keep e-collar and shirt on to prevent scratching Medicated baths Q72 hours, next one scheduled for tomorrow

6/05/2019

CBC -Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), ro chronic dz/inflammation vs other -Severe leukocytosis 42.32 K/uL (2.87-17.02) -Severe neutrophilia 36.07 K/uL (2.3-10.29), bands suspected -Severe basophilia 1.38 K/uL (0.01-0.26) Chem -Low cholesterol <6 mg/dL (65-225) PLAN: Start cefpodoxime 10 mg/kg PO SID x 7 days

7/05/2019

History 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds from pruritis. Impression smear (sample from skin fold in neck) showed TNTC cocci Convenia given. Simbadol, benadryl, topical entederm. E-collar and vest. 5/4 Medicated bath (under sedation). Benadryl switched from IM administration to SQ. Scheduled CBC/Chem but machine not working. 5/5 Extended simbadol, start gabapentin. Scheduled CBC/Chem because machine still not working. 5/6 CBC suggestive of overwhelming infection/inflammation. Start cleaning neck with chlorhex, cefpodoxime. -CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) -CHEM: Low cholesterol <6 mg/dL (65-225) S/O: BAR, eating well, vocal and attention seeking at front of kennel. No v/d noted. EENT: Eyes clear, ears -mod dark discharge AU, no nasal or ocular discharge noted Oral Exam: mm pink, CRT <2 H/L: Difficult to auscult over purring - no overt murmur, Lungs clear, eupnic MSI: Ambulatory x 4, BCS 4/9, inguinal and axillar regions - lichenification, milliary/diffuse papules. Ventral neck extending to sides of face - brown discharge within skin folds, greasy, excoriations and superficial lacerations from scratching. CNS: Mentation appropriate Assessment: Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs autoimmune vs other Secondary self inflicted wounds to neck Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other Anemia - ro chronic dz vs neoplasia vs other Plan: Removed e-collar as it appeared to be rubbing and not preventing scratching, but approx 2 hours after removing there were fresh red sratches along ventral neck. Medicated bath Placed soft padded neck bandage with telfa against ventral neck. Change bandage SID and clean neck as necessary Continue Cefpodoxime 10 mg/kg PO SID until 5/13 Continue gabapentin 20 mg/kg PO BID indefinitely DC cleaning neck with chlorhex BID (will do SID during bandage change) Recheck CBC on 5/13

8/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) 5/7-placed bandage around neck to prevent scratching. Subjective: BARH. No csvd. Eating and drinking well. Very friendly. Objective P = wnl R = wnl BCS 4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: clean adult dentition PLN: No enlargements noted H/L: NSR, Grade 2/6 HM, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4, no visible parasites, no masses noted, diffuse alopecia with plaques on ventrum and severe lichenification diffusely especially on neck and ventrum. There is purulent d/c on the ventral neck striking through bandage. not pruritic. CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Grade 2/6 HM Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs autoimmune vs other Secondary self inflicted wounds to neck Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other Anemia - ro chronic dz vs neoplasia vs other Plan: Placed soft padded neck bandage with telfa and SSD against ventral neck. (changed current bandage) Continue Cefpodoxime 10 mg/kg PO SID until 5/13 Continue gabapentin 20 mg/kg PO BID indefinitely Recheck CBC on 5/13 Rec echocardiogram with placement Prognosis: Fair

9/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) Subjective: BARH. No csvd. Normal BM and U. Great appetite. Very friendly and affectionate. Soft padded bandage mostly shredded. Removed bandage and will try to let it dry out but if she is scratching excessively will need another bandage. Objective P = wnl R = wnl BCS 4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: clean adult dentition PLN: No enlargements noted H/L: NSR, Grade 3/6 HM, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4, no visible parasites, no masses noted, diffuse alopecia with plaques on ventrum and severe lichenification diffusely especially on neck and ventrum. There is purulent d/c on the ventral neck that has improved since yesterday but when cleaning skin with chlorhex there was some bleeding CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Grade 3/6 HM Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs neoplasia vs autoimmune vs other Secondary self inflicted wounds to neck Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other Anemia - ro chronic dz vs neoplasia vs other Plan: Removed bandage and gently cleaned neck with chlorhex-if scratching will need new bandage Will need dermatology consult +/- biopsy +/- steroid trial Continue Cefpodoxime 10 mg/kg PO SID until 5/13 Continue gabapentin 20 mg/kg PO BID indefinitely Recheck CBC on 5/13 Rec echocardiogram with placement Prognosis: Fair to poor

10/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) 5/7: Second medicated bath under sedation, placed neck bandage. 5/8: Grade 2/6 heart murmur ausculted 5/9: Neck bandage replaced with e-collar. Heart murmur noted to be grade 3/6. Today, 5/10: Progress exam Subjective: BARH, no coughing/sneezing/vomiting/diarrhea. Appetite excellent, e-collar in place. Objective: P: WNL R: WNL BCS: 5/9 OP: Mucous membranes pink and moist. CRT <2. EENT: Eyes, ears, and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful CV: Grade 3/6 murmur. No arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Soft, nonpainful, no palpable masses. UG: FI, no mammary gland tumors noted, no discharge INT: Severe diffuse alopecia with lichenification on whole body, worst at neck and ventrum. Crusted discharge on ventral neck, no actively bleeding wounds. Cleaned with chlorhexidine. Patient became very irritated during cleaning and started attempting to scratch at neck. MS: Ambulatory x4, no pain on palpation of epaxials NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Assessment: -Grade 3/6 HM -Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs neoplasia vs autoimmune vs other -Secondary self inflicted wounds to neck -Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other -Anemia - ro chronic dz vs neoplasia vs other Prognosis: Fair to poor Plan: -E-collar in place, appears to be leaving area alone -Recommend echocardiogram, dermatology consult +/- biopsy or steroid trial with placement -Continue cefpodoxime 10 mg/kg PO q24h until 5/13 -Continue gabapentin 20 mg/kg PO q12h indefinitely -Start applying SSD to ventral neck area q24h after cleaning with chlorhex x 3d until 5/13, then assess response -Recheck CBC on 5/13 -NH notified--requires further diagnostics and care for management of clinical signs.

11/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) 5/7: Second medicated bath under sedation, placed neck bandage. 5/8: Grade 2/6 heart murmur ausculted 5/9: Neck bandage replaced with e-collar. Heart murmur noted to be grade 3/6. 5/10: Progress exam Subjective: BARH, no coughing/sneezing/vomiting/diarrhea. Appetite excellent, e-collar in place. Objective: P: WNL R: WNL BCS: 5/9 OP: Mucous membranes pink and moist. CRT <2. EENT: Eyes, ears, and nares clear bilaterally, no discharge noted. PLN: Small/soft/symmetrical/nonpainful CV: Grade 3/6 murmur, unchanged from previous exam. No arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Soft, nonpainful, no palpable masses. UG: FI, no mammary gland tumors noted, no discharge INT: Severe diffuse alopecia with lichenification on whole body, worst at neck and ventrum. Crusted discharge on ventral neck. Patient started scratching at neck and opened new wounds during cleaning, bleeding stopped quickly with pressure. MS: Ambulatory x4, no pain on palpation of epaxials NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. Assessment: -Grade 3/6 HM -Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs neoplasia vs autoimmune vs other -Secondary self inflicted wounds to neck -Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other -Anemia - ro chronic dz vs neoplasia vs other Prognosis: Fair to poor Plan: -Replaced e-collar with smaller size--evaluate tomorrow if too small and irritating area -Placed bandages over hind paws to prevent further trauma to neck -Recommend echocardiogram, dermatology consult +/- biopsy or steroid trial with placement -Continue cefpodoxime 10 mg/kg PO q24h until 5/13 -Continue gabapentin 20 mg/kg PO q12h indefinitely -Continue applying SSD to ventral neck area q24h after cleaning with chlorhex x 3d until 5/13, then assess response -Recheck CBC on 5/13 -NH notified--requires further diagnostics and care for management of clinical signs. -Change hind foot bandages q3d or earlier if soiled

12/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) 5/7: Second medicated bath under sedation, placed neck bandage. 5/8: Grade 2/6 heart murmur ausculted 5/9: Neck bandage replaced with e-collar. Heart murmur noted to be grade 3/6. 5/11: Bandage placed to dissuade itching SO: BARH, no csvd. Appetite excellent, e-collar in place. unremarkable elimination P: WNL R: WNL BCS: 5/9 EENT: Eyes clear. ears clean. no oc or nasal discharge noted. Oral: unremarkable adult dentition H/L: Grade 3/6 murmur, No arrhythmias, pulses strong and synchronous. Eupneic, no crackles/wheezes Abd: no palpable masses. UG: FI, no mammary gland tumors noted, no discharge MSI: Ambulatory x4, no pain on palpation of epaxials. Severe diffuse alopecia with lichenification on whole body, worst at neck and ventrum. Worst affected areas are dry and crusted with scabbing. NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. A: Grade 3/6 HM Severe pyoderma and dermatitis Secondary self inflicted wounds to neck Severe leukocytosis + neutrophilia - historic Anemia - historic Prog: Fair P: Recommend echocardiogram, dermatology consult +/- biopsy or steroid trial with placement Continue cefpodoxime 10 mg/kg PO q24h until 5/13 gabapentin 20 mg/kg PO BID Continue applying SSD to ventral neck area q24h after cleaning with chlorhex until 5/13 Recheck CBC and hemocrit tomorrow NH notified--requires further diagnostics and care for management of clinical signs. Clean hind foot bandages - will change q3d (next one 5/13) or earlier if soiled

13/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) 5/10-started on SSD and wound cleaning Subjective: BARH. No cvd but is sneezing with mild congestion. Eating well. Friendly but removing the bandages on her back legs was very painful for her and the bandages were covered in feces. Her skin is slowly improving but has a long way to go and may never be normal. Objective P = wnl R = wnl BCS 4/9 EENT: Eyes clear, ears clean, no ocular discharge noted, mild serous nasal d/c. Oral Exam: clean adult dentition PLN: No enlargements noted H/L: NSR, Grade 1/6 HM, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4, no visible parasites, no masses noted, diffuse alopecia with plaques on ventrum and severe lichenification diffusely especially on neck and ventrum. There are areas on her neck that are raw from scratching but overall seems improved CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Grade 1/6 HM-improved Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs neoplasia vs autoimmune vs other Secondary self inflicted wounds to neck Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other Anemia - ro chronic dz vs neoplasia vs other URI Plan: E-collar changed, very dirty Removed soft padded bandages on back legs-were very dirty and tape was irritating to skin Will need dermatology consult +/- biopsy +/- steroid trial Extend Cefpodoxime 10 mg/kg PO SID until 5/20-may need longterm treatment Continue gabapentin 20 mg/kg PO BID indefinitely Extend SSD cream on neck until 5/20 Start doxycycline 10mg/kg PO SID x10d until 5/23 Recheck CBC when machine is functioning Rec echocardiogram with placement Prognosis: Fair to poor **ADDENDUM** 4:41pm-placed soft padded bandage and socks due to cat scratching herself until she was bleeding around her neck

14/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) 5/7: Second medicated bath under sedation, placed neck bandage. 5/8: Grade 2/6 heart murmur ausculted 5/9: Heart murmur noted to be grade 3/6. 5/11: Hind limb bandages placed to dissuade itching Subjective: BARH, no coughing/vomiting/diarrhea. Marked serous nasal discharge and sneezing with congestion. Objective: P: WNL R: WNL BCS: 4/9 OP: Mucous membranes pink and moist. CRT <2. EENT: Eyes and ears clear bilaterally, no discharge noted. Marked serous discharge from nares and sneezing PLN: Small/soft/symmetrical/nonpainful CV: Grade II/VI murmur ausculted. No arrhythmias, pulses strong and synchronous. RESP: Eupneic, no crackles/wheezes GI: Soft, nonpainful, no palpable masses. UG: FI, no mammary gland tumors noted, no discharge INT: Severe diffuse alopecia with lichenification and crusting, particularly on ventrum and neck. Crusted self- inflicted wounds on neck, no fresh or bleeding wounds on exam today. MS: Ambulatory x4. Appears to be tolerating soft padded bandage and socks well, both bandages clean on exam today. NEURO: Mentation appropriate, cranial nerves intact, no deficits noted. CBC: Assessment: -Grade 1-2/6 HM -Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs neoplasia vs autoimmune vs other -Secondary self inflicted wounds to neck, appear to be improved with application of soft bandages to feet -Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other -Anemia - ro chronic dz vs neoplasia vs other -URI Prognosis: Fair to poor Plan: -Will need dermatology consult +/- biopsy +/- steroid trial -Continue Cefpodoxime 10 mg/kg PO SID until 5/20-may need longterm treatment -Continue gabapentin 20 mg/kg PO BID indefinitely -Continue SSD cream on neck until 5/20 -Continue doxycycline 10mg/kg PO SID x10d until 5/23 -Recheck CBC today if machine is functioning -Rec echocardiogram with placement

15/05/2019

Progress exam History: 5/3 os intake: severe dermatitis, pyoderma with secondary self inflicted wounds. Impression smear (sample from skin fold in neck) showed TMTC cocci. Convenia given and started on Simbadol, benadryl, topical entederm. E-collar and vest placed. 5/4 Medicated bath (under sedation). 5/5 Started gabapentin for shelter anxiety 5/6 Start cleaning neck with chlorhex, started on simplicef. CBC: Moderate regenerative anemia, Hct 23.2 % (30.3-52.3), Severe leukocytosis 42.32 K/uL (2.87-17.02), Severe neutrophilia 36.07 K/uL (2.3-10.29) + bands suspected, Severe basophilia 1.38 K/uL (0.01-0.26) CHEM: Low cholesterol <6 mg/dL (65-225) 5/10-started on SSD and wound cleaning 5/13-diagnosed with URI but accidentally did not start on doxy Subjective: BARH. Eating very well. Vomited once. Sneezing. Objective P = wnl R = wnl BCS 4/9 EENT: Eyes clear, no ocular discharge noted, mild serous nasal d/c. Oral Exam: clean adult dentition PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4, no visible parasites, no masses noted, diffuse alopecia with plaques on ventrum and severe lichenification diffusely especially on neck and ventrum. There are areas on her neck that are raw from scratching, lots of crusting on whole body especially around face, soft padded bandages on HLs to keep from scratching-cdi CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Grade 1/6 HM-not ausculted today Severe pyoderma, dermatitis - ro allergy (atopy v food v FBD) vs neoplasia vs autoimmune vs other Secondary self inflicted wounds to neck Severe leukocytosis + neutrophilia - ro diffuse pyoderma/dermatitis vs neoplasia vs other Anemia - ro chronic dz vs neoplasia vs other URI Plan: E-collar cleaned, scrubbed neck wounds with chlorhex Will need dermatology consult +/- biopsy +/- steroid trial Continue Cefpodoxime 10 mg/kg PO SID until 5/20-may need longterm treatment Continue gabapentin 20 mg/kg PO BID indefinitely Continue SSD cream on neck until 5/20 Start doxycycline 10mg/kg PO SID x10d until 5/25 (not started on 5/23) Rec echocardiogram with placement Prognosis: Fair to poor

4/05/2019

Grace was sedated with 0.05 ml Butorphanol amd 0.05 ml Dexmedetomidine for a Malaseb bath.

7/05/2019

Sedated with 0.05cc Butorphanol and 0.05cc Dexdomitor IM. Bathed with Malaseb Neck bandage placed by vet No reversal needed

6/05/2019

Lab results added to vet documents

14/05/2019

Blood work has been uploaded to vet documents

Details on my behavior are...

Behavior Condition: 3. Yellow

Behavior upon intake: Grace allowed to be picked up and place in a carrier. No further handling was done as she was rushed to vet services.

Date of Intake: 5/3/2019

Is this cat having litter box issues?: No

Basic Information:: Grace is a two and a half year old muted calico female cat that was surrendered to the center due to health concerns. The owner had her since she was a kitten and got her from a stray cat.

Previously lived with:: Two adults

How is this cat around strangers?: She is friendly around strangers.

How is this cat around children?: She was around an eight year old. She was relaxed and playful around him.

How is this cat around other cats?: She didn't live with other cats.

How is this cat around dogs?: She didn't live with other dogs.

Behavior Notes: She is not bothered when put in a carrier, being picked up and held. She struggled when being bathed

Bite history:: No bite history with a person or animal.

Energy level/descriptors:: Medium

Has this cat ever had any medical issues?: Yes

Medical Notes: Grace has a severe skin condition.

For a New Family to Know: She was described as friendly and affectionate. She likes to follow people around and be in the same room. She likes to play with balls, stuffed toys and strings. She was kept indoors only and used to eat a special diet for her skin. She had an uncovered litter box with clay litter.

KNOWN HISTORY:: Lived Indoors Previously lived with: Two adults Behavior towards strangers: She is friendly around strangers. Behavior towards children: She was around an eight year old. She was relaxed and playful around him. Behavior towards cats: She didn't live with other cats. Behavior towards dogs: She didn't live with other dogs. Bite or scratch history: None Litterbox training: Yes Energy level, descriptors: Medium She was described as friendly and affectionate. She likes to follow people around and be in the same room. She likes to play with balls, stuffed toys and strings. She was kept indoors only and used to eat a special diet for her skin. She had an uncovered litter box with clay litter.

MEDICAL BEHAVIOR:: 05/03/19 Observed Behavior - allowed handling, escalated to growling and trying to flee

Cage Condition:: Cage is neat

Reaction to assessor:: Grace is crouched in front of her kennel as the assessor approaches,ears forward.

Reaction when softly spoken to:: Grace vocalizes and pushes her nose through the door when softly spoken to.

Reaction to cage door opening:: Grace tries to escape her kennel as the cage door opens, then remains calm when pushed back into her kennel.

Reaction to touch:: Grace allows petting along her head and body while leaning in and raising her tail.

Reaction to being picked up:: Grace allows the assessor to pick her up and lift her from her kennel, body slightly tensed.

ACTIVITY LEVEL:: Moderate

VOCAL:: Quiet

CHARACTER TYPE: : Affectionate,Demanding

BEHAVIOR DETERMINATION: : Average

Behavior Asilomar: H - Healthy

BEHAVIOR SUMMARY:: Grace interacts with the observer, appreciates attention, is easy to handle and tolerates all petting. This cat is showing behavior appropriate for new or experienced cat parents.