KELLY – A1113878
Safe -
6-4-2017 Brooklyn
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SAFE 06/04/17
KELLY – A1113878
FEMALE, BROWN / BLACK, YORKSHIRE TERR MIX, 14 yrs
STRAY – STRAY WAIT, NO HOLD Reason STRAY
Intake condition GERIATRIC Intake Date 06/01/2017, From NY 11369, DueOut Date 06/04/2017,
Medical Behavior Evaluation BLUE
Medical Summary Estimated age: 14 yrs. Microchip noted on Intake? No. Stray dog, noted to appear geriatric, has cloudy eyes. Quiet, a little tense, allows all handling. EBARH. mm=pink, moist, CRT<2 s. HR=90, RR=24, BCS=3/9. ORAL: Mod. to severe calculus, gingivitis. EENT: Cataracts OU, pos but slow menace OU, pos PLR OU. No oculonasal discharge. Ears WNL. PLN: No enlargements noted. H/L: Lungs clear, no murmurs/arrhythmias. ABD: Non painful, no masses/organomegaly palpated. U/G: Female, no spay scar found. MS: Ambulatory x 4, no lameness. INTEG: Slightly thin haircoat, no skin lesions or fleas. CNS: Mentation appropriate – no signs of neurologic abnormalities. A: Approx. 14 yr old Yorkie with dental disease, cataracts, thin body condition. P: Scheduled for CBC/CHEM/T4. Fair to good prognosis with appropriate management.
Weight 6.8
RE-EXAM
06/02/17 : CBC shows very mild monocytosis (1.26K/uL) and mild non-regenerative anemia (34.7%). Chemistry shows mild increases in ALT (200U/L), GGT (15U/L), Globulins (4.6g/dL) and Lipase (3063U/L). Assessment — R/O mild anemia of chronic disease; mild biliary disease vs other. Plan — no treatment indicated at this time. Rec follow up blood work/routine geriatric panel to monitor for any changes that warrant specific treatment
Group Behavior::
Kelly was surrendered as a stray so her past behavior around dogs is unknown.
06/03/17: When off leash with dogs at the Care Center, Kelly is social, checking in on the other small male and female dogs as she explores.
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