11/12/2017

[DVM Intake] DVM Intake Exam Estimated age:2 Microchip noted on Intake? n History : stray Subjective: Observed Behavior -calm, allows exam Evidence of Cruelty seen -n Evidence of Trauma seen -n Objective T = P =60 R =wnl BCS 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: clean teeth PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: intact, 2 testes MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat–scar on right muzzle extending from nostril CNS: Mentation appropriate – no signs of neurologic abnormalities Assessment: healthy Prognosis:excellent Plan:neuter SURGERY: Okay for surgery

17/12/2017

Recheck for poss. “star-gazing” behavior: S/O: Quiet, mildly depressed demeanor – mild dehydration, BCS 5/9, T: 101.5 – no c/s v/d observed/reported – amb x 4, seems to become a little tired/reluctant to stand for long periods – snp abdomen – intact male – mentation is appropriate, on neurologic abnormalities appreciated A: mildly depressed attitude, older dog (not 3 yrs) P: no treatment at this time, cont. to monitor; changed age to 7 yr

23/12/2017

CBC: Mild anemia, mild mild neutrophilia and monocytosis. Chemistry – elevated BUN and creatinine (30 and 2.5). IRIS guidelines suggest that if this is renal azotemia, pt is in stage 3 or 4 of renal failure. Rec measure USG and re-assess. 1088

23/12/2017

[Spay/Neuter Waiver – Medical Condition] Your newly adopted pet has been diagnosed with chronic kidney disease and the staff veterinarians are issuing a permanent waiver from the spay/neuter requirements of the City of NY. Follow up care at your regular veterinarian is recommended to ensure continued treatment. Your veterinarian will advise you if surgical sterilization is appropriate.

23/12/2017

Mild Non-regenerative anemia (36.5) renal azotemia (creat 2.6 and Bun 31) mild hyperglobulinemia (4. UA SG 1010 w/ 3+ leukocytes and trace protein Rec 14 days of clavamox to r/o secondary uti/pyelonephritis Stage 3 ckd rec: prot:creat ratio to quantify protein loss, blood pressure monitoring, renal friendly diet, omeprazole, cerenia prn for vomiting.

26/12/2017

Hx: Pt was coughing yesterday – moved to isolation. S: Good energy level in kennel O: Repeated hoarse cough. No SND noted. A: CIRDC vs. coughing secondary to barking repeatedly P: Start doxycycline 300 mg PO SID x14 days; Cerenia 60 mg PO SID x4 days. Monitor cough and monitor for the development of nasal discharge. 1088

28/12/2017

Diagnosed with CIRDC due to hoarse cough on 12/26, moved to isolation and started doxycycline; was previously on clavamox S/O -BAR, appears friendly and energetic -barking at his neighbor in a friendly manner! -no nasal discharge, sneezing or coughing noted -appears eupnic A 1. Previous cough-r/o short course of CIRDC (possibly due to previous clavamox administration?) vs hoarse secondary to coughing P -okay to leave isolation -continue doxycycline

2/01/2018

Hx: Stage 3 CKD. Was moved to isolation with a presumptive diagnosis of CIRDC on 12/25/17; appeared healthy on 12/28 so moved out of isolation. S: Alert, energetic in kennel, barking O: Soft repeated cough, hacks up foam occasionally A: 1. CIRDC – relapse vs. not resolved 2. CKD P: 1. Move back to isolation, continue doxycycline 2. Add LRS 1 liter SQ SID x5 days – monitor to ensure it is all absorbed, otherwise decrease the volume 3. Feed renal diet – Hill’s K/D or Royal Canin Renal Support 1088

3/01/2018

Hx: diagnosed with stage 3 renal disease on intake due to azotemia, started on clavamox and SQF; diagnosed with CIRDC on 12/26 and appeared clear on 12/28 so was moved out of isolation but continued on doxycycline; reportedly coughing for the last 48 hours S/O -QAR, appears docile -excessive serous nasal discharge, no coughing or sneezing noted or reported -appears eupnic A 1. CIRDC, persistent/relapsed 2. Azotemia, moderate; r/o CKD vs pyelonephritis vs other P -move back to isolation -restart cerenia 60 mg PO SID x 3 days -continue doxycycline, recheck in 3 days -recommend rechecking chemistry on 1/6 after course of clavamox is complete

4/01/2018

Monitor overall health, suspect CKD and CIRDC S/O -BAR, appears energetic and friendly -good appetite -mild to moderate serous nasal discharge -appears eupnic A 1. Azotemia-r/o CKD vs pyelonephritis vs other 2. CIRDC-resolving P -CWCT, recheck u/a and chemistry scheduled for 1/6

7/01/2018

Recheck CIRDC, day 12 doxycycline S/O -BAR, very playful and energetic, sweet boy! -good appetite -no nasal discharge, sneezing or coughing noted -appears eupnic A 1. CIRDC-appears resolved 2. Azotemia on intake, moderate P -okay to move from isolation -recheck chemistry scheduled tomorrow -urinalysis run on 1/6 but no USG noted; 1+ leukocytes and pH 5 but test may not be accurate; these results are not diagnostic for assessing renal disease

8/01/2018

Hx: dx with CIRDC and cleared twice (most recently yesterday); today is last day of Doxycycline; dx with mild azotemia on intake but unable to recheck chemistry due to machine error S/O -BAR -mild harsh cough with intermittent end gag -reportedly vomited today, may be secondary to coughing -appears eupnic A 1. CIRDC, persistent/relapsed 2. Azotemia-r/o CKD vs other P -move back to isolation -baytril 136 mg tabs: 2 tab PO SID x 10 days -cerenia 60 mg PO SID x 4 days

11/01/2018

Hx: diagnosed with mild to moderate azotemia (creat 2.6) on intake which was suspected to be due to chronic renal disease and mild dehydration but was placed on clavamox for possible pyelonephritis; was doing great but then was diagnosed with CIRDC which appeared persistent so he was changed switched to baytril on 1/8; recheck chemistry today showed mild improvement in renal values S/O -BAR, playful and energetic -mild intermittent huffing cough -no nasal discharge or sneezing noted -good appetite -appears eupnic A 1. Cough-suspect persistent CIRDC but appears to be improving 2. Azotemia, improved, suspect chronic renal disease P -continue baytril -recommend urinalysis, signed up for tomorrow -recommend blood pressure monitoring -recommend continuing renal diet such as k/d and monitoring renal values and electrolytes frequently -prognosis: fair, suspect chronic renal disease which appears stable-improved but is likely to progress over time

12/01/2018

s/o: BAR no cirdc signs today on baytril until 1/17 overall look good recent blood still show mild azotemia a; chronic renal disease p: move out of iso recheck on 1/17/18 to decide if addtional work up for kidneys needed (urine culture perhaps)

18/01/2018

Recheck renal values last week showed mild improvement in creat/BUN but still mildly elevated, last USG recheck was 1.040; finished Baytril yesterday for CIRDC +/- possible pyelonephritis S/O -BAR, handsome and friendly boy! playing with toy in kennel -no reported concerns -good appetite with renal diet -no nasal discharge or sneezing -eupnic A 1. Mild azotemia with normal USG P -rec’d monitoring renal values every 4-6 weeks initially to ensure renal values are stable -rec’d continuing k/d diet for now, if renal values improve to WNL and USG continues to be normal, then can consider switching to maintenance diet in the future

26/01/2018

Hx: Renal disease – azotemia and concurrent isosthenuria/hyposthenuria, intermittent hematuria. Pt developed CIRDC and has since recovered. For the last week pt has been doing well with occasional hematuria but this morning pt urinated a very large bright red stream. He also vomited today, and has been lethargic in his kennel. S: Quiet in kennel – lying down, unwilling to get up. Once walking on leash, pt is alert and walks around but seems quieter than on previous exams – not excited to get out and move around. O: Temp 99.1 deg F. QAR, adequate hydration. MMs pink and moist, CRT <2 sec EENT: No discharge OU, AU, nose. PLNs: Not significantly enlarged. H/L: Eupnic, not ausculted Abd: Soft, no pain on palpation, no masses palpated M/S/I: Amb x4. No skin lesions noted. UG: Male intact, testicles soft and symmetrical. Rectal: Prostate slightly enlarged, not bilobed Neuro: Alert and appropriate, no sign neurological deficiencies A: 1. Hematuria, mild azotemia – R/O pyelonephritis, UTI, prostatitis, prostatic neoplasia, TCC, other Short-term prognosis: Fair P: 1. CBC/chemistry/UA today 2. Abd rads +/- chest rads 1088

26/01/2018

1/26/18 1/22/18

26/01/2018

1/26/18 1/12/18 BUN 35 28 (7-27) CR 2.2 2.2 (0.8-1.8) HCT 35.9 40.4 (37.3-36.1) Mild progression of azotemia r/o hydration, renal dz Mild anemia r/o loss, 2nd to chronic dz, other

26/01/2018

Could not obtain radiographs without sedation and Marist clinical appearance was consistent with an increased risk of sedation. Also need ua sample either free catch or cysto if sedated tomorrow. Ate k/d in medical. Place on IVF 60 ml/ hour as supportive care.

Dog is friendly and allows handling

Date of intake:: 12/11/2017

Spay/Neuter status:: No

Means of surrender (length of time in previous home):: Stray

Bite history:: Yes, Marist bit another dog while interacting in the care center. Please see Playgroup notes for additional details.

Date of assessment:: 12/13/2017

Look:: 1. Dog’s eyes are averted, with tail wagging and ears back. Allows head to be held loosely in Assessor’s cupped hands.

Sensitivity:: 1. Dog stands still and accepts the touch, eyes are averted, and tail is in neutral position with a relaxed body posture. Dog’s mouth is likely closed for at least a portion of the assessment item.

Tag:: 1. Dog follows at the end of the leash, body soft.

Paw squeeze 1:: 1. Dog does not respond at all for three seconds. Eyes are averted and ears are relaxed or back.

Paw squeeze 2:: 1. Dog does not respond at all for three seconds. Eyes are averted and ears are relaxed or back.

Flank squeeze 1:: Item not conducted

Flank squeeze 2:: Item not conducted

Toy:: 1. Dog settles close, keeps a firm grip and is loose and wiggly. Dog does not place his/her body between you and the toy.

Summary:: Marist approached the assessor in the assessment room with a soft body. He was social throughout the assessment, allowed all handling, and displayed no concerning behaviors.

Summary:: Due to the recently observed potential for Marist to escalate without known provocation, a single pet home is recommended for Marist. Though he has previously displayed social behavior toward other dogs, Marist has escalated to biting and holding on to the face of another dog without clear provocation or warning.

Summary (1):: 12/12: When introduced off leash to the female greeter dog, Marist is soft, social, and bouncy at play. 12/13: Marist continues to engage in bouncy, running play. At times he attempts to mount select female dogs.

Summary (2):: 12/14: Marist displays playful, social behavior toward female dogs. He responds well to receiving correction from dogs who are less interested in play. He appears soft and wiggly when greeting a male on the other side of the gate.

Summary (3):: 12/15-18: Marist engages in bouncy play with playful female dogs. He attempts to mount a select female dog and will continue to follow, sniffing, despite corrections.

Summary (4):: 12/19-21: Marist engages in play with female dogs.

Summary (5):: 12/22: Marist engages in play with a group of female dogs. When play slowed down, he approached a select female and lunged and bit her face, causing puncture wounds.

Date of intake:: 12/11/2017

Summary:: Marist was friendly and allowed handling.

Date of initial:: 12/11/2017

Summary:: Marist was calm and allowed handling,

ENERGY LEVEL:: We have no history on Marist so we cannot be certain of his behavior in a home environment. In the care center, he displays a medium level of activity.

IN SHELTER OBSERVATIONS:: Marist remains calm in the shelter environment and social with handlers. He maintains a loose wiggly body throughout interactions and solicits attention from handlers.

BEHAVIOR DETERMINATION:: EXPERIENCE (suitable for an adopter with some previous dog experience, especially with the behaviors outlined below)

Behavior Asilomar: TM – Treatable-Manageable

Recommendations:: Single-pet home,Recommend no dog parks

Recommendations comments:: Single pet home/no dog parks: Due to the recently observed potential for Marist to escalate without known provocation, a single pet home is recommended.