3/27/2025

DVM Intake Exam Estimated age: approx 1-3 years based on dentition and conformation Microchip noted on Intake? scanned negative History: stray Subjective: BAR Observed Behavior - enters with loose body solicits attn, resisted MC and blood but allowed for tasks Is there evidence of Cruelty? N Is there evidence of Neglect? N Is there evidence of Trauma? N Objective T = np P = wnl R = wnl BCS 4.5/0 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: mild wear and staining to visible dentition PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: MI, two scrotal testes MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: rectal prolapse repair- purse string suture in place, some FS6 present around anus Assessment Rectal prolapsed- repaired at offsite- prolapse still reduced Prognosis: good Plan: intake exam and tasks house in med-icu Con't on lactulose as written 6mL PO BID x 7 days Con't on capro 75mg PO SID x 5 days Con't gaba 200mg PO BID x 7 days recheck tomorrow- adjust lactulose dose as needed SURGERY: Okay for surgery: N Temporary waiver due to rectal prolapse repair

3/28/2025

Recheck rectal prolapse, reduced 3/26. Medical records indicate hematochezia, painful/tenesmus, diarrhea noted on 3/27 - discontinued lactulose at that time and added proviable and panacur, also started cerenia, metronidazole, psyllium husks, buprenorphine. Patient also on trazodone and gabapentin for anxiety in care. S/O: BAR, active and vocal/wailing in kennel, e-collar in place Eating well no c/s/v noted, diarrhea with no tenesmus, bleeding from anus appreciated after walk EENT: No ocular or nasal discharge, cherry eye LUNGS: Eupneic MSI: Ambulatory x 4 with no notable lameness RECTAL: purse string suture visible, mild hemorrhage from rectum/anus following walk/defecation - resolved on its own A: Rectal prolapse - reduced 3/26 Mild hemorrage - suspect rectal Diarrhea FAS P: Discontinue lactulose Continue gabapentin and carprofen for pain Start panacur 55 mg/kg PO SID x 3 days Start proviable 1 cap PO SID x 7 days Start trazodone 8 mg/kg PO BID for FAS in kennel Monitor diarrhea/rectal prolapse closely and adjust treatment plan as needed

4/1/2025

Recheck rectal prolapse S/O: BAR, very active/hyperactive in kennel at times Eating well, diarrhea FS 5-6/7 in kennel, no tenesmus or hematochezia reported EENT: Cherry eye, no ocular or nasal discharge LUNGS: Eupneic RECTAL: purse string in place, reactive to brief rectal exam no obvious abnormalities A: Rectal prolapse - reduced 3/26 Diarrhea Cherry eye FAS P: Start psyllium husk PO BID Continue trazodone for FAS, proviable for diarrhea CTM closely and recheck in 2 days

4/3/2025

recheck rectal prolapse, D+ S/O BAR, A+A, no c/s/v, reportedly still have D++ (none in kennel aTT), no reported tenesmus/straining EENT: no ocular or nasal dc, cherry eye OS HL: eupneic MSI: amb x 4 Rectal: purse string in place, p resists rectal exam A. rectal prolapse - purse string D++ r/o infectious vs colitis (part Frenchie?) P. Change p diet to i/d diet for now- no treats recheck 4/5 - if D persists, possible to put him on GI biome (frenchie colitis?)? Purse string has now been on for 10 days on 4/5, consider sedated exam/removal. Metronidazole ~20mg/kg PO BID x 5 days (375mg) (first dose given tonight)

4/5/2025

Recheck - rectal prolapse reduced at outside vet on 3/26, presented to ACC with purse string in place; persistent diarrhea with no response to treatments. Sedated for AXR and rectal exam - dexmedetomidine 0.01 mg/kg IM + butorphanol 0.2 mg/kg IM. S/O: BAR, active and eating well, no c/s/v noted, spots of diarrhea all over bedding, quickly soils fresh bedding as well EENT: Cherry eye OS, no discharge OU; mild mucoserous nasal discharge ORAL: mild-mod tartar, stage I ddz LUNGS: Eupneic RECTAL: Crusted feces in perianal fur, purse string intact and slightly loose (removed during exam) - constricting ring palpated in rectum, palpated digitally approx 4-5 cm from anus, does not relax, unable to pass finger through AXR: -On the lateral view there is a focal region of gas at cranioventral abdomen, it is noted ventral to a focal region of mixed opacity ingesta/stool (ro stomach vs colon) -On the VD view the region of gas and region of ingesta/stool overlap. Both have large diameter - would be normal for stomach but increased diameter for SI or LI. Rule out gas in stomach vs SI vs LI; rule out ingesta/stool in stomach vs SI vs LI (concern for fecal impaction) -Open physes noted at proximal tibia, distal femur A: Suspect circumferential rectal stricture - ro congenital vs trauma vs infiltrative disease Persistent diarrhea Large area of gas and ingesta/stool on rads - ro fecal impaction vs other Young dog/puppy Dental disease CIRDC P: Adjusted age for this dog due to presence of open physes - estimate 8-14 months. Removed purse string Scheduled bloodwork Start doxycycline 10 mg/kg PO SID x 10 days for CIRDC Discontinue metronidazole Concern for rectal stricture, seek placement asap for internal medicine consult. Will need treatment for stricture, surgery is sometime necessary. CTM closely in ICU

4/6/2025

Blood collected for CBC/CHEM/T4 to idexx

4/8/2025

Recheck, bloodwork results S/O: BAR, active, no c/s/v noted Diarrhea FS 6 with some hematochezia spotted throughout bedding EENT: Moderate mucoid nasal discharge LUNGS: Eupneic RECTAL: Externally unremarkable CNS: Appropriate mentation CBC: platelets H 502 (143-448) CHEM: BUN L 8 (9-31), sodium L 134 (142-152), chloride L 100 (108-119) T4: wnl A: CIRDC Rectal stricture, cicumferential - ro congenital vs trauma vs infiltrative dz Persistent diarrhea Large area of gas and ingesta/stool on rads - ro fecal impaction vs other Hx rectal prolapse Dental disease P: Continue doxycycline, trazodone, psyllium husk CTM closely on rounds, seek placement asap