Three view chest radiographs complete. Bloodwork completed 10/31/17. Urine specific gravity needed–scheduled 11/1/17.

DVM Intake Exam Estimated age:8-10 YO MC Chihuahua mix Microchip noted on Intake? neg on DVM intake History : owner surrender. hx of coughing, heart murmur relayed to previous owner Subjective: BARH, starts coughing with excessive handling and gets very nervous/worked up Objective BCS: 3/9 HR: 100 RR: 24 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: not done d/t stress PLN: No enlargements noted H/L: Grade V/VI left sided heart murmur with palpable cardiac thrill. Harsh lungs bilaterally, no evidence of crackles or wheezes. mild tachypnea ABD: Non painful, no masses palpated U/G: MC MSI: Ambulatory x 4, abducted thoracic limbs CNS: Mentation appropriate – no signs of neurologic abnormalities Rectal: grossly normal Assessment: geriatric MC Chihuahua mix 1. severe heart murmur 2. coughs with stress 3. thin bcs (3/9) 4. abducted thoracic limbs r/o anatomical vs secondary to tachypnea Prognosis: poor with care Plan: 1. chest radiographs – 3 view ideal 2. full bloodwork and urinalysis 3. start vetmedin and Lasix pending thoracic radiographs *discussed above with pet team manager and ACC veterinary staff 4. no intake procedures (vaccinations/preventatives/microchip) d/t high level of stress 5. RECOMMEND APPOINTMENT WITH CARDIOLOGIST ASAP ONCE BEING ADOPTED

elevated creatine 1.6 r/o dehydration vs early stage of renal disease HCT low :36% (low normal is 37) anemia secondary to chronic disease vs other

Presented with severe heart murmur, cough and mildly labored breathing that increased with stress/handling; blood work showed mild anemia and creat of 1.6 only one lateral thoracic radiograph available for review due to worsening of dyspnea with added stress; shows moderate cardiomegaly with mild to moderate interstitial pattern in perihilar-caudal lung field; mild collapsed trachea or redundant tissue at thoracic inlet S/O -QAR, nervous trembling; allows handling if you go slowly; gets stressed very easily -mm pk, tacky; CRT <2 sec; severe dental disease -scant serous nasal discharge, may be behavioral -mildly increased respiratory rate and mild increase in inspiratory effort, difficult to determine if it is behavioral; does not appear in respiratory distress -grade V-VI systolic heart murmur -quiet lung sounds diffusely -mild expiratory cough with added stress and handling -severe abduction of shoulders bilaterally; appears to have normal range of motion at elbows with no changes A 1. Heart murmur/cardiomegaly-r/o valvular vs other 2. Cough-worsens with handling; r/o CHF vs bronchitis vs collapsing trachea vs combination vs other 3. Dental disease P Gave 0.3 ml torb IM for stress reduction and cough suppressant Repeated CXR Lasix 50 mg/ml: 0.17 ml SQ BID until placement urinalysis with USG recommend cardiac consultation immediately after placement

Was able to take 2 view thoracic radiographs while sedated with torb; overall technique poor due to machine malfunction Moderate to severe cardiomegaly with dorsal deviation of trachea; mild patchy perihilar interstitial pattern A Cardiomegaly with mild CHF-r/o valvular disease vs other

Sedated yesterday for hind limb radiographs; had short seizure under sedation which resolved with antisedan S/O -QAR, docile -mild appetite -mm pk, sl tacky; CRT <2 sec -mild serous nasal discharge, no sneezing or coughing noted -eupnic, heart/lungs WNL -slightly tense on abdominal palpation -spay scar CDI -grade III-IV/VI RH lameness A Seizure under sedation-resolved RH hip luxation, dysplasia P Continue rimadyl Rec’d FHO after placement

Patient presented to MACC medical for radiographs and CBC/Chem from the intake team. 1 view right lateral chest radiographs obtained. Was not able to obtain additional radiographs due to patient stress/coughing. Blood drawn from Right cephalic vessel. Radiograph and CBC/Chem to be evaluated by DVM. 1398

Three view chest radiographs complete. Bloodwork completed 10/31/17. Urine specific gravity needed–scheduled 11/1/17.

SPECIFIC GRAVITY -1.038 ALL OTHER PARAMETERS ARE NORMAL AS PER DR 1382

Details on my behavior are…