LEVIN – A1109427

Manhattan Center

My name is LEVIN. My Animal ID # is A1109427.
I am a male white and black staffordshire mix. The shelter thinks I am about 3 YEARS old.

I came in the shelter as a STRAY on 04/20/2017 from NY 10475, owner surrender reason stated was STRAY.

04/23/2017 AT RISK MEMO
A1109427 Levin is At Risk for medical reasons, please see exam below

MOST RECENT MEDICAL INFORMATION AND WEIGHT
04/22/2017 Exam Type RE-EXAM – Medical Rating is 4 NC – SEVERE CONDITIONS NOT CONTAGIOUS, Behavior Rating is NONE, Weight 53.0 LBS.

04/22/17 14:03 Hx: bilateral forelimb lameness noted on intake 4/20 L>>R S: very sweet, energetic, a bit nervous, allows full exam with no restraint O: well hydrated EENT: no discharge AU/OU/nares Oral: Int: dirty malordorous haicoat, interdigital erythema, brown discoloration at nailbeds Lnn: WNL CV: NMA, s&s pulses, pink moist mm Resp: clear lungs, eupnic Abd: SNP UG: intact male, soft symmetrical testis MS: BCS 5/9 – non wt bearing on LFL, swelling on medial elbow – carpal laxity/hyperextension on RFL Neuro: BAR, no obvious neuro deficits, complete neuro exam not performed A: RFL carpal hyperextension (fracture vs tendon injury vs other) LFL lameness (fracture vs joint dz vs other) interdigital dermatitis and onychitis P: sedated with 0.5ml Dexdormotor (0.5mg/ml) IM and 0.5ml Butorphanol (10mg/ml) IM, reversed with 0.5ml Antisedan IM 1.1ml Hydromorphone SQ once 2.5ml Cerenia SQ once 2.5ml Convenia SQ once for skin infection Rads: comminuted fracture of the L olecranon involving humoral-Radial-ulna joints place with NH ok for surgery, or permanent waiver if fracture repair and neuter at same time px: good with appropriate treatement, splinting will be detrimental due to elbow joint involvement (unable to stabilize joint above elbow with splint, recommed primary fixation (ex-fix vs pins) or amputation

04/20/2017 PET PROFILE MEMO
04/20/17 10:44 On intake, Levin had a waggy tail and loose body. He was limping and couldn’t put pressure on his left front paw but that didn’t stop him from nudging the counselor’s arm for pets. Counselor was able to pet his head and back and rub his body with a wet wipe to get some of the dirt off his back. He allowed counselor but did not sit when asked. He stood nicely for pictures. When it was time to wait for medical, Levin laid on counselor’s feet.

04/22/2017 WEB MEMO

04/21/2017 BEHAVIOR EVALUATION – AVERAGE
Exam Type BEHAVIOR
KNOWN HISTORY: None Date of Intake 4/21/2017 Unaltered male, stray Other notes: Levin was very social upon intake. SAFER ASSESSMENT: Date of assessment Look: 1. Dog’s eyes are averted. His ears are back, her tail is down, and he has a relaxed body posture. Dog allows head to be held loosely in Assessor’s cupped hands. Sensitivity: 1. Dog stands still and accepts the touch, his eyes are averted, and his tail is in neutral position with relaxed body posture, open mouth Tag: 1. Follows at end of leash, body soft, tail wagging Flank Squeeze 1 / 2: 1. Dog does not respond at all. Toy 1. Minimal interest. Dog smells, more interested in interacting with the handler Summary: Levin displayed no concerning behavior during his assessment. Flank was used for Squeeze item due to medical concerns with front paw. PLAYGROUP: When greeting a female dog through the fence, Levin greets politely with soft body and wagging tail. He will solciit play through the fence. He is not introduced off leash due to apparent limb lameness. MEDICAL BEHAVIOR: Date of Initial 4/20/2017 During his initial medical exam, Levin was easy to handle and social. ENERGY LEVEL: We have no history on Levin so we cannot be certain of his behavior in a home environment. Levin is a young, enthusiastic, social dog. We recommend only force-free, reward based training techniques for Levin. RECOMMENDATIONS: Average (suitable for an adopter with an average amount of dog experience)

GROUP BEHAVIOR EVALUATION 
No Group Behavior Summary

04/20/2017 DVM INTAKE PHYSICAL EXAM
Medical rating was 3 NC – MAJOR CONDITIONS NOT CONTAGIOUS, behavior rating was NONE
DVM Intake Exam Estimated age: 2-3 years Microchip noted on Intake? none History : brought in as a stray , found roaming around an apartment building Subjective: BAR Observed Behavior – sweet, friendly, easy to examine Evidence of Cruelty seen – none Evidence of Trauma seen – yes, bilateral forelimb lameness, mild abrasion on L shoulder Objective BCS 4/9 EENT: mild periocular erythema, nose clears; ears clear Oral Exam: mm pk, moist; CRT <2 sec; mild tartar, no obvious dental abnormalities PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: 2 normal descended testicles MSI: dirt around nail beds, overall hair coat is dull/dirty with sm amnt of mud in fur over dorsum small healing abrasion on L shoulder LF- grade III lameness; holds paw with carpus in flexion-apparent neurologic deficit, mild-mod swelling of elbow with pain on extension; hyperflexion of carpus with mild swelling along medial aspect of carpus; mild atrophy of shoulder musculature RF-grade II lameness with significant hyperflexion of carpus; no pain on extension of shoulder or elbow; no obvious discomfort on ROM of carpus; digits splayed due to increased weight bearing LH-mild stifle effusion with discomfort on extension; good ROM in hips RH-mild thickening of stifle, no discomfort CNS: mentation appropriate absent CP on LF with decreased withdrawal normal CP on RF with absent withdrawal Rectal: not performed Assessment 1. LF lameness-suspect combo of neurologic damage and orthopedic injury to elbow and carpus 2. RF lameness-carpal hyperextension, r/o primary carpal injury or secondary to prolonged increased weight bearing suspect old trauma such as HBC; likely old fracture of elbow that has been healing without intervention as well as some nerve damage Plan Rimadyl/Tramadol radiographs of forelimbs may require arthroscopy of elbow +/- carpal arthrodesis pending response to meds and rads Prognosis: fair to good pending radiographs; will likely have significant arthritis in L elbow and carpus bilaterally and will require indefinite treatment that may include but not limited to chronic daily joint supplement, chronic pain medications, weight/diet management and controlled activity; the neurologic function could improve with time and overall mobility is likely to improve with pain medications alone SURGERY: Okay for surgery

04/22/2017 RE-EXAM (LAST MAJOR EXAM)
Medical rating 4 NC – SEVERE CONDITIONS NOT CONTAGIOUS,
04/22/17 14:03 Hx: bilateral forelimb lameness noted on intake 4/20 L>>R S: very sweet, energetic, a bit nervous, allows full exam with no restraint O: well hydrated EENT: no discharge AU/OU/nares Oral: Int: dirty malordorous haicoat, interdigital erythema, brown discoloration at nailbeds Lnn: WNL CV: NMA, s&s pulses, pink moist mm Resp: clear lungs, eupnic Abd: SNP UG: intact male, soft symmetrical testis MS: BCS 5/9 – non wt bearing on LFL, swelling on medial elbow – carpal laxity/hyperextension on RFL Neuro: BAR, no obvious neuro deficits, complete neuro exam not performed A: RFL carpal hyperextension (fracture vs tendon injury vs other) LFL lameness (fracture vs joint dz vs other) interdigital dermatitis and onychitis P: sedated with 0.5ml Dexdormotor (0.5mg/ml) IM and 0.5ml Butorphanol (10mg/ml) IM, reversed with 0.5ml Antisedan IM 1.1ml Hydromorphone SQ once 2.5ml Cerenia SQ once 2.5ml Convenia SQ once for skin infection Rads: comminuted fracture of the L olecranon involving humoral-Radial-ulna joints place with NH ok for surgery, or permanent waiver if fracture repair and neuter at same time px: good with appropriate treatement, splinting will be detrimental due to elbow joint involvement (unable to stabilize joint above elbow with splint, recommed primary fixation (ex-fix vs pins) or amputation

Generated on Apr 23 2017 6:01PM

 

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