[Spay/Neuter Waiver – Age] It is the policy of ACC not to perform surgery on any animal over the age of 8-10 years due to the higher risks incurred in a shelter setting. The veterinarian is hereby issuing a permanent spay/neuter waiver, from the spay/neuter requirements of the City of NY due to the estimated age of this animal. ACC does recommend you consult with your veterinarian to determine if surgical sterilization is appropriate.

[DVM Intake] DVM Intake Exam Estimated age: 10 Microchip noted on Intake? neg History : Came in as stray but possibly o surrender Subjective: QAR- 8% dehydrated. Observed Behavior -Cautious and very nervous. Did most of exam without muzzle. Evidence of Cruelty seen -n Evidence of Trauma seen -n Objective T = P = 90 R = eup BCS= 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Minimal tartar but yellow teeth and mod wear, broken L max canine. PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Distended pendulous abd. Firm very large mass cranial abd. Not painful. U/G: female – no spay scar seen, prominent vulva and mammary glands, no discharges, no MGT’s MSI: Ambulatory x 4 but crepitus felt in pelvis and knees. Skin free of parasites. No skin masses noted. Healthy hair coat but white around eyes and muzzle. Dorsal muscle wasting. CNS: Mentation appropriate – no signs of neurologic abnormalities Rectal: not done Assessment: Cranial abd mass or organomegaly. Dehydrated. Prognosis: Guarded Plan: Xray tomorrow. SQF 150 cc today. Re-check VC tomorrow. +/- BW. Urinated – SpGr=1.049. Unable to get some for dipstick. SURGERY: Permanent waiver due to age.

Progress exam-cranial abdominal mass Subjective: QAR- ~5% dehydrated. No c/s/v/d Objective P = wnl R = eup BCS= 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Muzzled PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Very large mass palpated in top 2 quadrants of abdomen that is firm and round U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4 but severe crepitus felt in pelvis and stifles bilaterally. Skin free of parasites. No skin masses noted. Healthy hair coat. Cachexia and underweight CNS: Mentation appropriate – no signs of neurologic abnormalities Assessment: Severe cystitis r/o UTI vs neoplasia vs other Dehydrated Severe crepitus in stifles and hips r/o fractures vs severe OA Cachezia Underweight OA in pelvis and stifles Anemia Prognosis: Poor Plan: 2 view AXR-bladder is very large taking up the majority of the abdomen and displacing the GI dorsal and cranially, no other obvious abnormalities VD pelvis and stifles-thickening of femoral neck and osteophytes CBC-anemia 26.6 (37.3-61.7) Chem-hyperproteinemia 8.4 (5.2-8.2) with hyperglobulinemia 5.9 (2.5-4.5) UA pending collection Telazol 0.4ml IM given for radiographs Keep in medical for daily monitoring Start LRS 20ml/kg SQ BID x3d until 11/23 Start clavamox 13.75mg/kg PO BID x14d until 12/5 Start baytril 10mg/kg PO SID x10d until 12/1 Start rimadyl 4.4 mg/kg PO SID x14d until 12/5-may need to extend Rec internal medicine consult with AUS

Progress exam-very large, firm bladder History: 11/21-very large firm mass palpated on intake 2 view AXR-bladder is very large taking up the majority of the abdomen and displacing the GI dorsal and cranially, no other obvious abnormalities VD pelvis and stifles-thickening of femoral neck and osteophytes CBC-anemia 26.6 (37.3-61.7) Chem-hyperproteinemia 8.4 (5.2-8.2) with hyperglobulinemia 5.9 (2.5-4.5) Subjective: QARH. No c/s/v/d. Bladder is very large and firm. No urine in cage. Great appetite. Objective P = wnl R = eup BCS= 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Very large bladder palpated in top 2 quadrants of abdomen that is firm U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4 but stiff gait with severe crepitus in hips and stifles. Skin free of parasites. No skin masses noted. Healthy hair coat. Cachexia and underweight CNS: Mentation appropriate – no signs of neurologic abnormalities Assessment: Severe cystitis/enlarged/firm bladder r/o neoplasia vs UO vs other Dehydrated-resolved Severe crepitus in stifles and hips r/o fractures vs severe OA Cachexia Underweight OA in pelvis and stifles Anemia Prognosis: Poor needs AUS to r/o TCC especially since no sign of UTI on bw and UA Plan: UA-proteinuria, ascorbic acid ++, pH 7, USH 1.015 Keep in medical for daily monitoring LRS 20ml/kg SQ BID until 11/23 clavamox 13.75mg/kg PO BID until 12/5 baytril 10mg/kg PO SID until 12/1 rimadyl 4.4 mg/kg PO SID until 12/5-may need to extend Rec internal medicine consult with AUS

Recheck – Severe cystitis S/O: BARH. Allows all handling. Excellent appetite. Normal urine appearance EENT: Nuclear sclerosis, no ocular or nasal discharge HL: No coughing or sneezing ABD: Soft, non tender, no masses palpated, urinates large amount of urine when bladder palpated INTEG: WNL MS: Thin, ambulatory x 4, significant crepitus in hips and stifles UG: Female A: Geriatric, underweight R/O osteoarthritis vs injury vs other R/O severe cystitis/UTI vs neuropathy vs neoplasia vs other P: Continue with current treatment and monitoring plan. Consider abdominal ultrasound

Cage exam – monitor condition S/O: QARH. Eating with excellent appetite. Clean cage. EENT: Nuclear sclerosis, no ocular or nasal discharge HL: No coughing or sneezing INTEG: WNL MS: Ambulatory x 4, thin/muscle wasted UG: Female A: Geriatric, R/O cystitis/UTI vs neoplasia vs other; R/O osteoarthitis vs injury vs other P: Continue with current treatment and monitoring plan.

Progress exam-very large, firm bladder History: 11/21-very large firm mass palpated on intake 2 view AXR-bladder is very large taking up the majority of the abdomen and displacing the GI dorsal and cranially, no other obvious abnormalities VD pelvis and stifles-thickening of femoral neck and osteophytes CBC-anemia 26.6 (37.3-61.7) Chem-hyperproteinemia 8.4 (5.2-8.2) with hyperglobulinemia 5.9 (2.5-4.5) 11/22: UA-proteinuria, ascorbic acid ++, pH 7, USH 1.015 Subjective: QARH. No c/s/v/d. Bladder is very large and firm. Urinating and defecating on her own. Great appetite. There is a fluid bubble on her back from LRS given 2 days ago. Snarls with full PE. Objective P = wnl R = eup BCS= 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Very large bladder palpated in top 2 quadrants of abdomen that is firm U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 4 but stiff gait, full ortho exam not done due to pain. Skin free of parasites. No skin masses noted. Healthy hair coat. Cachexia and underweight CNS: Mentation appropriate – no signs of neurologic abnormalities Assessment: Severe cystitis/enlarged/firm bladder r/o neoplasia vs UO vs other Dehydrated-resolved Severe crepitus in stifles and hips r/o fractures vs severe OA Cachexia Underweight OA in pelvis and stifles Anemia Prognosis: Poor needs AUS to r/o TCC especially since no sign of UTI on bw and UA Plan: Keep in medical for daily monitoring clavamox 13.75mg/kg PO BID until 12/5 baytril 10mg/kg PO SID until 12/1 rimadyl 4.4 mg/kg PO SID until 12/5-may need to extend Rec internal medicine consult with AUS

Upon intake Love Lace was relaxed and allowed the counselor to collar her and pet her with no issue.