10/1/2024

DVM Intake Exam Estimated age: 1-2 years based on the condition of teeth and eyes Microchip noted on Intake? Negative History: Stray Subjective: QAR marked jaundice and pale Observed Behavior - Body relaxed; easily examined; social Evidence of Cruelty seen - No Evidence of Trauma seen – No Evidence of Neglect- No Objective P = 200hr R = 40rr BCS 2/9 eating; normal BM; urinating EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: marked icterus PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI with 2 down MSI: Ambulatory x 4, emaciated, dull hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment icterus anemia emaciated weakness r/o mycoplasma vs hepatic lipidosis and starvation vs infiltrative disease vs other Prognosis: Poor Plan: FeLV/FIV- -negative PCV- 8% and markedly jaundice Consider EHR after stray hold expedited Lost and Found Doxycycline- 50 mg/ml sig: 1/2 ml po q 24 hrs x 2-4 weeks SURGERY: permanent waiver due to weakened state PM rounds: eating very well

10/2/2024

Progress exam S/O: QAR, leaning into head rubs and pets, lifting bum when scratched AS2 overnight and this AM; seen drinking water from bowl multiple times this AM, eating also from wet food tray EEN: No ocular or nasal discharge RESP: Eupneic MSI: Decreased skin turgor, weak on ambulation; mild-moderately icteric A: Icterus - continued but appears improved since intake Anemia - PCV 8% on intake 10/1 Emaciated Generalized weakness PU/PD Prognosis: Poor to fair Plan: Stray hold ends on 10/7 *Keep in medical, monitor appetite and weight *Start LRS 50ml SQ q24h x 3 days *Continue doxycycline as prescribed *Recheck PCV in-house, and carry out CBC/Chem/TT4 to send out on 10/5 to allow bloodwork to be assessed for changes and underlying concerns as may inform whether or not EHR is recommended.

10/4/2024

Hx: emaciation, marked anemia, icterus S: BAR, allows all handling, ate well o/n and this morning. Normal urine and feces in litterbox Reweigh- 6.0 lbs (gaining) O: EENT- Eyes clear, ears clean, no nasal or ocular discharge H/L- NSR, NMA, lungs clear, eupneic, CRT <2 sec. MSK/I- Ambulatory x4, decreased muscle mass, healthy hair coat. Icteric mucus membranes and integument. ABD- soft non-painful Neuro- alert/appropriate A: Anemia on intake (8%)- concern for possible infectious disease vs. other Icterus Eating well Gaining weight P: Continue with doxycycline AFAST- liver appears to be WNL, no obvious mucoceole or pathology noted. Would benefit from full ultrasound Monitor in care Prioritize placement and leaving the shelter ASAP

10/5/2024

CBC HCT 4.8% (30.3-52.3) Hgb 2.0 g/dL (9.8-16.2) WBC 17 K/uL Mild neutrophilia 14 K/uL Mild monocytosis 0.8 K/uL CHM Glucose 94 mg/dL SDMA 26 ug/dL (0-14) Creatinine 0.9 mg/dL BUN 29 mg/dL Hypernatremia 168 mmol/L Hypokalemia 3.3 mmol/L Hyperglobulinemia 6.0 g/dL ALT 806 U/L (12-130) ALP WNL GGT WNL Bilirubin 10.4 mg/dL A: Severe anemia- appears non-regenerative vs. pre-regenerative Neutrophilia- r/o infection vs. other Elevated SDMA + electrolyte derangements- r/o secondary to dehydration/ malnutrition vs. other Elevated ALT- r/o infectious vs. inflammatory vs. other Marked elevation in bilirubin- r/o infectious vs. toxic vs. other Prognosis: guarded P: Continue with current treatment plan Consider EHR if not eating/declining

10/6/2024

Pet is eating and resisting restraint for radiographs. 10/5 blood work ALT 806 high ALP 28 wnl GGT 0 Tbili 10.4 high Rads: Chest WNL Abdomen: No foreign bodies or masses seen. AFAT: No free fluid. No masses seen. r/o IMHA vs EHBDO vs other Plan Sedated with Dexdomitor 0.5mg/ml 0.1ml + Butorphanol 10mg/ml 0.1 ml im Recheck manual PCV tomorrow +/- Prednisolone

10/7/2024

PCV: 7% TP: 9

10/7/2024

Pet BAR and eating. Anemia not improving on doxycycline. Plan Prednisolone 5 mg 1 tablet po sid x 14d then reassess.

10/8/2024

Issue List: - marked anemia - marked hyperbilirubinemia - underweight QAR eating canned EENT: no nasal or ocular discharge noted; jaundice pinnae, sclera and gingiva H/L: eupneic PLN: WNL ABD: relaxed U/G: MI MSI: Ambulatory x 4, normal hair coat CNS: Mentation quiet - no signs of neurologic abnormalities A) working diagnosis- IMHA P) CWSC Consider EHR

10/9/2024

pale jaundice weak eating canned food gained some weight

10/11/2024

SO: In medical on treatment for severe anemia and icterus. Suspected IMHA either primary or secondary to FIA BAR, seeking attention and head butting. eent: eyes clear, no ocular or nasal dc apparent, mm jaundiced h/l: mild tachypnea, no coughing or sneezing appreciated msi: ambulatory x4 neuro: mentation alert and appropriate A: anemia-on treatment underweight-gaining weight P: continue current treatment plan clinically improving

10/13/2024

Hx: anemia and jaundice eating appears less jaundice P) CWSC

10/14/2024

PCV: 11-12%

10/14/2024

HCT improving at 11 to 12% now Pet has good energy and is eating. Plan c/w Prednisolone 5mg sid and recheck pcv in 2 weeks

10/16/2024

Issue List: - working diagnosis IMHA - anemia and jaundice QAR H eating canned food EENT: no nasal or ocular discharge noted H/L: eupneic PLN: WNL ABD: relaxed U/G: MI MSI: Ambulatory x 4, normal hair coat CNS: Mentation quiet - no signs of neurologic abnormalities A) anemia and jaundice; seems to be improving working dx- IMHA P) CWSC

10/17/2024

SO: In medical on treatment for severe anemia. Has started to regenerate. Currently on doxycycline and prednisolone BAR, comes to kennel door, head butting and seeking attention eent: eyes clear, serous nasal dc apparent h/l: eupneic, sniffling and evidence of sneezing appreciated msi: ambulatory x4 neuro: mentation alert and appropriate A: URI-mild anemia P: monitor appetite closely continue current treatment plan adding fortiflora 1 sachet PO SID x7d