3/1/2018

Anesthesia Summary: Feline OHE Pre Medication/Induction: Propofol 10 mg/ml – 2.38 ml IV, once. Dexdomitor 0.5mg/mL injectable, 0.1 mL IM, once Butorphanol 10mg/mL injectable, 0.1 mL IM, once Anesthesia Notes: Size 3.5 fr. ET tube placed, maintained general anesthesia throughout procedure on isoflurane and O2. Used (rebreathing) system with 1 L bag. 22 g IVC placed in RFL cephalic vessel. Intraoperative IV LRS at 5-10mL/kg/hr: 61 mL/hr NSAID: Robenacoxib (Onsior) 20mg/mL injectable, 0.6 mL, SQ, once, for post-operative pain relief. Given pre/post operatively. Other Simbadol 1.8mg/mL injectable, 0.80 mL SQ, once, for pain relief, given post-operatively. Recovery Uneventful Anesthetist/Surgical Monitor 1390/0992 Start 0.80 cc simbadol 1.8 mg/ml sid x 2 days and 0.6 cc Robenacoxib 20 mg/ml sid x 2 days as pain management.

3/2/2018

Temp as of 11:45 pm is 101.4 QAR Does move around in her cage As of right now April does not have an appetite Will continue to monitor overnight

3/1/2018

DVM Intake Exam and Sx notes: Estimated age: mature adult, ~ 3-5 yrs Microchip noted on Intake? scan negative on intake Microchip Number (If Applicable): placed 981020025006112 History : stray Subjective: QARH Observed Behavior - tense, will flee, allowed handling with restraint/towel Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = wnl BCS 8/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: MM pink, chipped left max. canine tooth (204) PLN: No enlargements noted H/L: NSR, NMA, CRT < 2; Lungs clear, eupnic ABD: tense abd., overweight, did not seem painful on palp., no masses palpated; shaved abd. revealed ~3-4 cm scar w/suture lines (no tattoo) U/G: female with hx of vaginal d/c on intake; no d/c observed; mammary glands mildly firm to touch/expressed and yielded small amount of milky fluid 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 CBC/Chem: mild neutrophilia/decr. platelets nosf; r/o infect/inflamm., stress vs other Rads: VD/R lat. abdomen = R. Lat. view: mass effect in caudal abdomen displacing bladder ventrally; VD view: large tortuous ST opacities on R/L sides of bladder/caudal abdomen => enlarged uterus r/o pyometra, hydro vs other A: pyometra vs other Px: open-fair Sx notes: large, moderately distended tortuous uterine horns/body (with dark brown, watery fluid inside), overweight/fatty, nosf otherwise routine OHE = Ventral midline incision approach; each ovarian pedicle auto-ligated and excised distal to ligatures; broad ligament vessels auto-ligated; uterine body ligated with two modified-Miller's knots/ligatures using 3-0 Monocryl and excised distal to ligatures; body wall closed with cruciate pattern using 3-0 Monocryl; subcutaneous/intradermal layers closed with continuous pattern using 3-0 Monocryl; green-ink tattoo placed lateral to spay incision; surgical glue applied to skin incision and over tattoo site to assist with closure P: cont. post-op pain management + monitor attitude/appetite + recheck bloodwork + LRS IV @ 10 ml/hrs overnight and reassess in the morning + cont. 180 mg Ampi/Sulbactam IV tonight and begin Clavamox 1 ml PO BID x 7 days (if eating)

3/2/2018

CBC/Chem: mild neutrophilia/decr. platelets nosf; r/o infect/inflamm., stress vs other Rads: VD/R lat. abdomen = R. Lat. view: mass effect in caudal abdomen displacing bladder ventrally; VD view: large tortuous ST opacities on R/L sides of bladder/caudal abdomen => enlarged uterus r/o pyometra, hydro vs other

3/2/2018

Hx: Pyometra. Spayed on 3/1/18, started on Unasyn overnight and Clavamox this morning. Simbadol for pain control. Did not eat this morning. Vet assistant reports that pt eats when she spoon-feeds her but will not reach out for food. S: Hiding under blanket. Alert, allows handling but slightly tense. O: BAR-H, BCS 7/9, MMs pink EENT: No discharge OU, AU, nose. PLNs: Not significantly enlarged. H/L: Eupnic, not ausculted Abd: Slightly tense. No masses palpated. M/S/I: Amb x4. No skin lesions noted. UG: Female, no vulvar discharge or mammary masses Neuro: Alert and appropriate, no sign neurological deficiencies A: Post-op pyometra, tense abd, poor appetite Short-term prognosis: Fair P: 1. Continue Simbadol - extend when this rx runs out 2. Continue Clavamox 3. Add Baytil 22.7 mg/ml 1.3 ml IV *slowly* SID x5 days 4. Re-assess tomorrow; consider abd rads vs. CBC/chemistry vs. other 1088

3/3/2018

Recheck for post-op pyo: decr. appetite reported Current tx: IV LRS @ 15 ml/hr + IV baytril + Clavamox S/O: Quiet, hiding in back of kennel, decr. appetite reported EENT: nsf, no d/c, no c/s; MM pink CRT <2 H/L: nsf Abd: soft on palp., mildly enlarged mamma, spay incision healing well clean/dry/intact) MSI: amb x 4, overweight BCS 7/9 Mentation: appropriate CBC/Chem: neutrophilia (increased from before surgery), slight thromobcytopenia (improved post-op), decr. BUN r/o infect/inflamm. (recovering pyo.) vs stress vs other A: anorexia, fearful behav. + recovering OHE/pyo P: cont. with current tx (abt's/pain meds) + maint. on IV LRS @ 10 ml/hr overnight + monitor appeite + 1/4 Mirtazipine 15 mg tab PO q72 x 3 doses

3/4/2018

Recheck for post-op pyo: Current tx: IV LRS @ 10 ml/hr + IV baytril + Clavamox + mirtazapine S/O: QARH, BCS 7/9 - Caution fearful hiding under bedding + becomes mildly fractious with prolonged handling - decr. appetite, will take nutrical when fed - offering different wet foods to assess appetite - eent clean/clear - h/l nsf - incision clean/dry/intact, no swelling/discharge - amb x 4 A: recovering post-op OHE (pyo), appears stable but fearful and not sure how much she is eating P: moving out of medical discont. IV fluids and IV antibiotics + cont. Clavamox PO + and cont. monitor appetite

3/7/2018

At back of kennel. Ate both dry and wet food today. Pt recovering well from sx. 1088