4/15/2026

DVM Intake Exam Estimated age: ~6-8 yr Microchip noted on Intake? Negative History: Owner surrender Subjective: QAR Observed Behavior - quiet, uncomfortable Is there evidence of suspected cruelty? Yes Objective: T = NT P = WNL R = WNL BCS 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: moderate dental tartar PLN: No enlargements noted H/L: NSR, grade III/VI HM, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MC MSI: Ambulatory x 3, severe swelling of LHL-more significant around stifle, non-weight bearing on LHL, withdrawal present on LHL skin free of parasites, no masses noted, urine on hind limbs and perineum and caudal ventral abdomen CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: not performed Wood's Lamp Exam: not performed Assessment: ~6-8 yr MC DSH LHL femoral fracture (at least 5 days old per previous owner) Dental disease HM Prognosis: Fair Plan: Dexdomitor (500 mcg/ml)-10 mcg/kg-0.1 ml and Butorphanol (10 mg/ml)-0.2 mg/kg-0.1 ml IM, reversed equal volume antisedan IM 2v CXR-NSF, no obvious rib fractures, bates body in abdomen 2V LHL-severely displaced comminuted fracture of distal femur with displacement of patella CBC/Chem/T4/proBNP to IDEXX Zorbium 6-16 lb topically once Onsior 20 mg/ml-2 mg/kg-0.5 ml SQ once Onsior 6 mg PO SID x 2 days starting tomorrow as long as renal values are ok Recommend amputation, recommend recheck prior to amputation and consider radiographs of pelvis and RHL to assure patient will do well with LHL amputation Recommend echocardiogram.

4/16/2026

CBC: HCT 20.1 (L) Retics 13.2 (L0 mild H WBCs (19.3) with H monos (1.27) CHEM: wnl TT4 wnl Cardiopet pending

4/16/2026

Recheck: S/O BAR, sitting in the back of the kennel, food trays mostly disturbed, no c/s/v/d appreciated, no ocular or nasal dc, leaning on R side, significant swelling to LHL A. Femoral fx - appears comfortable aTT P. Awaiting cardio-pet P needs repeated ortho rads to asssess for pelvic trauma and eval possibility of limb amputation. Scheduled for sedated pelvic rads tomorrow - will perform today if time allows. CTM while at QACC

4/16/2026

Addendum: Cardiopet proBNP: 330 (H) A. Cardiopet proBNP >270pmol/L Abnormal. NT-proBNP concentration is compatible with increased stretch and stress on the myocardium. Rec echo with placement or adopts- obtain full ortho rads (including pelvis) prior to full prognosis. Amputation might not be possible if pelvic fx

4/17/2026

Attempted to sedate for recheck radiographs However, patient is on zorbium until 4/18. Added 0.12ml dexmedetomidine IM (~12mcg/kg) but only achieved mild sedation - patient continued to be reactive. After 15 minutes, elected to reverse due to likely underlying heart disease and reschedule sedation. Sedation to be rescheduled once zorbium is off system to utilize better sedatives - caution, patient has heart murmur with high pro-BNP. Did well on combination of torb/dex on intake. Do not re-administer zorbium if surgery is planned, instead use simbadol. Cerenia 0.54ml SQ given due to nausea 2ndary to sedation

4/18/2026

Progress exam and repeat radiographs S/O: BAR, friendly. eating well. Urinating in kennel but appears to posture, not leak. No feces produced. Pink mm. left sided 3/6 systolic murmur with strong synchronous pulses. LHL severely swollen, unchanged from exam findings on 4/15. ANESTHESIA: Due to cardiac disease, elected to anesthetize using: -IV catheter placed -Propofol IV to effect -Intubated and maintained on isoflurane Did not administer midazolam 0.2mg/kg IV as able to induce smoothly with propofol. *P was stable under anesthesia and recovered well. RADIOGRAPHS: No obvious pelvic fractures Mineralized round structure left of midline in abdomen at level of kidneys A: Heart murmur grade 3/6 consistent Abnormal proBNP - r/o HCM Bates body - incidental radiographic finding; benign necrosis of fat Mild obstipation P: Schedule for amputation surgery ASAP Administered enema using red rubber catheter and warm soapy water, inserted into rectum and instilled 20ml - no feces produced while under anesthesia. Start: -Simbadol 0.24mg/kg TOMORROW, repeat daily until surgery - *do not give on day of surgery* -Gabapentin 100mg PO q12h indefinitely **DO NOT REPEAT ZORBIUM UNTIL AFTER SURGERY**

4/19/2026

Brief progress exam S: BARH - friendly, soliciting attention. P sternal in front and L lateral on hind end pink moist mm, CRT <2s no stool since ATH last urination 4/18 in PM great appetite no c/s/v/d reported O: Comfortable on light palpation of LHL A: HX LHL femoral fx No BM - hx mild obstipation, enema given 4/18 HX cardiomyopathy (HM w abnormal pro BNP) P: ADD Lactulose 3mL PO BID x3d --> 4/21 Otherwise CWCP DVM recheck 4/20 LH amputation scheduled 4/22 IH CONSIDER THE FOLLOWING ANESTHETIC PLAN: IVC, premed w methadone (0.4mg/kg IV) and (onsior 2mg/kg SQ) and induce w propofol (max 13.2mg/kg - give first half slowly over 60sec then titrate up slowly over 60sec to full dose if needed for adequate induction of anesthesia) to effect, maintain on isoflurane given hx of significant cardiomyopathy Consider intra op local nerve block for additional analgesia

4/20/2026

recheck, L femoral fx and constipation, enema admun 4/18, started on lactulose 4/19, no stool noted since enema given S/O BAR, A+A, no c/s/v/d appreciated, hasn't have BM since enema, fair- excellent appetite noted over the week EENT: no ocular or nasal dc HL: 3/6 HM GA: small amount formed stool palpable in colon MSI: good skin turgor, amb x 3 but perfers to still, significant swelling the LHL A. fractured LHL femur Hx of constipation r/o second inability to posture due to leg injury cardiomyopathy P. No enema performed today- p has higher ax risk d/t heart murmur, only small amount of stool present and want to reduce the number of times sedated Brief recheck tomorrow - consider enema then if p noted to be severely constipated, if not consider performing enema with surgery scheduled 4/22 CTM while at QACC

4/21/2026

Recheck fractured HL and constipation S/O: QAR at back of kennel, not eating, no defecation, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: Moderate amt of firm/hard stool palpable throughout colon MSI: Ambulatory x 3, drags LHL A: Femoral fx LHL Constipation Anorexia vs hyporexia P: Manually milked feces distally in colon (abd palpation) and able to remove 3 hard pieces (total 8-10cm) *Became much brighter following removal of feces - trying to escape, BAR at front of kennel, eating baby food well. Start SQ LRS 100 ml SID Start medical feedings BID Start miralax 1/4 tsp PO SID Limb amputation scheduled tomorrow, consider removal of more feces if constipation persists

4/22/2026

Pre-Op Exam S/O: BAR, no c/s/v/d noted EENT: No ocular or nasal discharge noted Lungs: Eupneic, normal respiratory rate/effort ABD: No obvious distention MSI: Ambulatory x 4, no notable lameness CNS: Mentation appropriate A: Appears to be suitable candidate for anesthesia, ASA status I P: Accepted for surgery - leg amputation today NEUTERED PRIOR Left hind amputation performed at the coxofemoral joint. Ligated vessels with 3-0 PDS, Bupicaine and Lidocaine splash block of muscle and into sciatic nerve. Closed muscle layers with 3-0 PDS in simple continuous pattern. SQ closed in similar fashion, skin closed with intradermal pattern using 3-0 Monocryl. Convenia 0.55 ml SQ

4/23/2026

[Post Surgical Exam] Attitude/demeanor: QAR, laying in back of kennel, doesn't move when called, purring and accepting/allowing pets Appetite: Appears to be eating little to none of morning feed, 4/23 AM C/S/V/D: None reported/seen Incision site: Some red coloring on incision site, no swelling, pus, bruising, or bleeding noticed/noted; sutures appear intact Pain level: Appears to be slightly uncomfortable Licking, chewing, or biting surgical site noted: None reported/seen Additional notes: Some redness on incision area noted, P didn't move when examined. Alerted DVM/Rounds specialist. -992230

4/23/2026

Recheck post-op limb amputation, zorbium and onsior given with sx S/O: QAR at back of kennel, warms with petting and lured to the front with churu, didn't eat regular cat food, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: No feces palpated in colon MSI: Ambulatory x 3, surgery site CDI A: Post op amputation Hx constipation - resolved today P: Continue gabapentin, miralax, medical feedings, and SQ LRS. Start onsior 6 mg PO SID CTM on rounds and recheck in 2 days

4/24/2026

Recheck 2d post-op limb amputation S: QARH - at back of kennel but leans into pets - friendly initially but hissing / raising paw in warning for deep abdominal palpation pink moist mm good appetite for high value food no c/s/v/d noted Support staff note no urination or defecation this AM O: EENT: No ocular or nasal discharge LUNGS: Eupneic ABD: Soft, P hissing / raising paw with deep palpation - No overt feces palpated in colon, moderately sized soft bladder MSI: Ambulatory x 3, L hip incision CDI with minimal swelling, no pain on light palpation A: Post op LH amputation Hx constipation - not appreciated today No urine - susp P urinating on bedding, no evidence of urinary obstruction @tt Reactive to abdominal palpation r/o behavior vs less likely painful P: CWCP CTM on rounds and recheck 4/25 as scheduled

4/25/2026

Recheck 3d post-op LHL amputation S: QARH - laying RLAT on bed, appears comfortable, purring during PE Great appetite - finished most of food No c/s/v/d Normal urination, no defecation since arrival O: EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral: Moderate dental tartar, pale pink & moist MM PLN: No enlargements noted H/L: NSR, grade 3/6 left-sided HM, CRT < 2, Lungs clear, eupneic MSI: Ambulatory x3, comfortable on palpation surrounding LHL incision, sutures intact and incision healing appropriately with minimal swelling CNS: Appropriate mentation - no signs of neurologic abnormalities A: Post-op LHL amputation Grade 3/6 left-sided HM - r/o HCM vs other Hx of constipation - did not palpate abdomen today, no defecation noted since arrival Prognosis: Fair P: Continue gabapentin and miralax DVM recheck 4/26 - fecal check/abdominal palpation to determine if constipated (consider lactulose or manual removal), recheck comfort level (consider zorbium if painful)

4/26/2026

Recheck 4d post-op LHL amputation S: QARH - laying sternal on bed, appears comfortable, purring during PE Great appetite - finished most of food No c/s/v/d Normal urination, no defecation since arrival (but digital removal of feces on 4/21) O: EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral: Moderate dental tartar, pale pink & moist MM PLN: No enlargements noted H/L: NSR, grade 3/6 left-sided HM, CRT < 2, Lungs clear, eupneic ABD: Firm but depressible stool in colon MSI: Ambulatory x3, comfortable on light palpation surrounding LHL incision, sutures intact and incision healing appropriately with minimal swelling CNS: Appropriate mentation - no signs of neurologic abnormalities A: Post-op LHL amputation Grade 3/6 left-sided HM with abnormal proBNP - r/o HCM vs other Constipation persists despite laxative therapy Prognosis: Fair P: Warm water / lubricant (~20cc) / lactulose (~10cc) enema performed Rectal - 2 hard stool segments ~2cm each in descending colon just out of reach, not able to remove digitally, no stool in rectum Continue gabapentin and miralax as RXd DVM recheck 4/27 Added to ARL - may need prokinetic medication (not available in shelter)

4/27/2026

Recheck 5d post-op LHL amputation S: QARH - laying sternal on bed, appears comfortable, purring during PE pink moist mm, CRT <2s Great appetite for wet food No c/s/v/d Moderate amount of 5/7 stool in litterbox - First bowel movement ON OWN since ATH on 4/15 O: EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral: Moderate dental tartar PLN: No enlargements noted H/L: NSR, HX grade 3/6 left-sided HM, CRT < 2, Lungs clear, eupneic - purring today, difficult to auscultate ABD: No palpable stool in colon @tt MSI: Ambulatory x3, comfortable on light palpation surrounding LHL incision, sutures intact and incision healing appropriately CNS: Appropriate mentation - no signs of neurologic abnormalities A: Post-op LHL amputation Grade 3/6 left-sided HM with abnormal proBNP - r/o HCM vs other Constipation - improved Prognosis: Fair P: Continue gabapentin as RXd EXTEND/INCREASE Miralax to 1/2 tsp PO BID --> 5/4 - recc continuing until P is defecating on own consistently DVM recheck 4/29 On ARL - may need prokinetic medication (not available in shelter) Consider GI fiber responsive diet with placement

4/29/2026

Recheck one week post HL amputation, constipation has persisted S/O: BAR, at front of kennel, eating, no defecation overnight or today, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Ambulatory x 3, LHL amputee - sx CDI and healing well; haircoat slightly unkempt ABD: No palpable stool in colon CNS: Appropriate mentation A: Constipation LHL amputation Heart murmur Dental disease P: Continue miralax BID and gabapentin BID CTM closely on rounds for regular defecation

4/29/2026

Post Surgical Exam Attitude/demeanor: BAR Appetite: eating well C/S/V/D: none Incision site: no swelling, bruising, or bleeding; sutures appear intact Pain level: appears comfortable Licking, chewing, or biting surgical site noted: No Additional notes:N/A

upon intake: he was taken directly to medical