10/13/2019

[DVM Intake] DVM Intake Exam Estimated age: 8yrs Microchip noted on Intake? N History: stray - found in building Subjective: BAR Observed Behavior - relaxed, allowed all handling Evidence of Cruelty seen - N Evidence of Trauma seen - N Objective T = 101.4F P = 190 - occasional skipped beats R = 24 BCS 4/9 EENT: Eyes clear, mild ceruminous debris AU - positive pinnal-pedal reflex, no nasal or ocular discharge noted Oral Exam: Grade 2-3/4 dental tartar, adult dentition PLN: No enlargements noted H/L: intermittent arryhythmia (1-2 beats over 60 seconds) - occasional dropped beats, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, full caudal abdomen (uterus?) U/G: Suspected intact female, mucopurulent vulvar discharge - suspect open pyo, multiple mammary masses R mammary chain MSI: Underweight, ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally normal Wood's Lamp Exam: Not performed Assessment: older (~8yr) FI DSH 1) Suspected open pyometra - mucopurulent vulvar discharge 2) Multiple mammary masses primarily R mammary chain 3) Otitis externa AU (pruritic) 4) Dental disease Prognosis: Fair to good pending diagnostics +/- surgery Plan: 1) CBC 2) Chem 3) T4 4) 2-view AXR: suspect uterus/pyometra - tubular soft tissue structure in caudal abdomen 5) Ear cleaning AU 6) Admin'd Tresaderm AU 7) LRS @ 10ml/hr (~75ml/kg/day) 5) Rec surgery tomorrow SURGERY: Okay for surgery

10/14/2019

S: pre spay exam hx of open pyometra O: eyes clear, no ocular or nasal d/c female intact, pus d/c from vulva heart ok no murmurs detected, lungs clear mammary masses both mammary chains A: pyometra mammary masses P: spay biopsy incisional 3 view chest xrays no obvious metastases

10/14/2019

Cat Spay Was this cat in heat, pregnant or have a pyometra? pyometra Ventral Midline Incision Ovaries Ligated with: 2-0 PDS 2x modified Miller's Uterine Body Ligated with: 2-0 PDS 2x modified miller's Abdominal Closure: midline closed 2-0 PDS in simple continuous, sc closed using 3-0 PDS in simple continuous pattern, skin closed intradermal with small amount of tissue glue Green Linear Tattoo Placed parallel to Midline Surgeon: 1697 Additional Comments: incisional biopsy mammary mass elliptical incision around mass, blunt dissection of sc tissues and removal of mass sc closed simple cont using 3-0 PDS, skin closed intradermal and small amount of tissue glue mass sent for histopath

10/15/2019

SO: pyometra sx and mammary mass bx performed yesterday QAR in kennel Allows handling not eating sx wounds CDI minimal dc from vulva fat paw LF A: healing pyometra fat paw P: removed IV catheter give convenia 0.34ml sc once continue pain relief

10/16/2019

SO Post op pyometra and mammary mass removal. P is BAR in kennel and has a good appetite. P allows handling for exam EN -- eyes and nose are clear, no discharge. Skin -- incision sites are clean, dry. No discharge A post op pyometra mammary tumors -- excised P ok to move up to adoptions

10/18/2019

MICROSCOPIC DESCRIPTION: The mammary gland is expanded by a poorly encapsulated, multilobular, invasive neoplasm composed of ducts and tubules separated by scant to abundant fibrous connective tissue supported by small to medium amounts of fibrovascular and scirrhous stroma. The ducts and tubules are lined by one to several layers of closely packed cuboidal to columnar epithelial cells which often pile up and fill the lumen. Mitoses are common and mitotic atypia is present. Focally extensive central necrosis is also seen. MICROSCOPIC INTERPRETATION: Mammary adenocarcinoma. Mitotic count: 16 Margins: The mass abuts the tissue margins. Complete excision cannot be confirmed. Vascular invasion: Not confirmed, but several suspicious areas are present. COMMENTS: Feline mammary carcinomas are malignant neoplasms with the potential to metastasize widely to regional lymph nodes and visceral organs. Mammary tumors are estimated as the third most common tumor in cats, representing 12% of feline tumors overall (irrespective of sex). Over 85% of feline mammary tumors are malignant. The average age of affected cats is 10-12 years old. The Siamese breed has been associated with an increased risk of mammary neoplasia. Malignant mammary tumors occur most often in female cats spayed late in life (or not at all), although these neoplasms can also occur in males. Cats spayed before 1 year of age have a significant reduction in the risk of developing mammary carcinoma later in life. Administration of exogenous progestins significantly increases the risk of mammary neoplasia in both male and female cats. Feline mammary carcinomas are characteristically biologically aggressive, but the range of reported survival times varies widely. Mortality is generally high (80-90%). Tumor diameter, extent of surgery (radical versus partial mastectomy), grade and clinical stage have been shown to be prognostically significant. Larger tumors ( greater than 3 cm diameter) have been associated with reduced survival times. There is progressive reduction in survival with increased stage (12-29 months for stages I and II, 6-9 months for stage III, and 1 month for stage IV). Lymphovascular invasion and lymph node metastasis are associated with shorter survival times. References: Meuten, ed. (2017), Tumors in Domestic Animals, 5th ed., chapter 17; Mills et al. (2015), Vet Pathol 52(2): 238-249; Zappulli et al. (2015), Vet Pathol 52(1): 46-60; Morris J (2013), J Feline Med Surg 15(5): 391-400; Hughes K et al. (2012) Vet J 194(1):19-26

10/14/2019

Anesthesia Summary: Feline OHE Pre Medication/Induction: Ketamine 100mg/mL injectable, 0.17mL IM Dexdomitor 0.5mg/mL injectable, 0.07mL IM Butorphanol 10mg/mL injectable, 0.07mL IM Propofol 10 mg/ml injectable, 1.35mL IV Anesthesia Notes: Size 3.5 fr. ET tube placed, maintained general anesthesia throughout procedure on isoflurane and O2. Used non-rebreathing system with 0.5L bag. 20g IVC placed in r cephalic vessel Intraoperative IV LRS at 5-10mL/kg/hr: 16mL/hr Peri-Operative NSAID/ Pain Med: Simbadol 1.8mg/mL injectable, 0.45mL SQ, once, for pain relief, given post-operatively. Onsior 20mg/mL injectable, 0.34mL, SQ, once a day for 4 days beginning the day after surgery. Recovery Status: Uneventful Post-operative Medications Prescribed: Cat Spays (Greater than 4 months old): Simbadol 1.8mg/mL injectable, 0.45mL, SQ, once a day for 4 days beginning the day after surgery. Onsior 20mg/mL injectable, 0.34mL, SQ, once a day for 4 days beginning the day after surgery. Onsior Dose: 2mg/kg Simbadol Dose: 0.24mg/kg Anesthetist/Surgical Monitor (P#’s): 1608/1544