SKY – 19490
RTO SAFE 04/06/18
SKY – 19490
Care Center Location: Brooklyn , ZIP Code From: 11232, Intake Type: Owner surrender (DOH)
Medical Behavior: Yellow , Age: 7 years, Sex: Female, Weight: 73 lbs
DVM Intake Exam; Estimated age: ~7-8yrs; Microchip noted on Intake? No; History : Owner surrender, one DOH VB hold after fight with other dog in house; Subjective: BARH; Observed Behavior – Tense, allowed soft muzzle to be placed, low growled once while cleaning wounds; Evidence of Trauma seen – Yes, minor bite wounds; Objective ; P = WNL; R = WNL; BCS 6/9; EENT: Nuclear sclerosis, scleral injection OU, mild debris AU, ears cropped short, no nasal or ocular discharge noted; Oral Exam: Mild dental staining, pink mm; PLN: No enlargements noted; H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic; ABD: Non painful, no masses palpated; U/G: Female, ~2cm firm mass at left cranial abdominal mammary gland; MSI: Ambulatory x 4, skin free of parasites, healthy hair coat, superficial wounds at left side of head near base of ear and along edge of left ear, wound at right side of muzzle, abrasion at left side of nose, no other wounds noted; CNS: Mentation appropriate – no signs of neurologic abnormalities; Assessment: Senior/geriatric, mammary gland tumor, bite wounds, overweight; Prognosis: Fair; Plan: Continue to monitor while at BACC. Wounds cleaned with nolvasan. SURGERY: Permanent waiver due to age
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