DVM Intake Exam Estimated age: ~8yrs Microchip noted on Intake? Yes History : Owner surrender due to medical condition – has not eaten in two days Subjective: Observed Behavior – QARH. Nervous but allows all handling. Ate small amount of food but appears too painful to eat Evidence of Cruelty seen -no Evidence of Trauma seen -yes Objective P =WNL R =WNL BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Moderate dental tartar PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: Female, no spay scar noted, bloody vaginal discharge – from vulva and staining tail and hind limbs MSI: Ambulatory x 4, skin free of parasites, no masses noted, dirty hair coat, blood crusting hind end CNS: Crouched position in front end (downward dog position), painful in neck when trying to lift head/neck Assessment: R/O trauma vs neurologic disease vs neoplasia vs other Prognosis: Fair Plan: IVC placed in left cephalic vein, 350ml bolus of LRS given over 20 minutes, maintenance fluids given until 8p. Rimadyl 1.6ml SQ given. Recheck tomorrow SURGERY: Temporary waiver due to condition

Monitor condition – presented inappetant with neck pain T 102F P 100 R 20 S/O: QARH. Allows all handling. Took outside for walk, walked well on leash, normal urination. Ate with excellent appetite when returned. EENT: Dental disease, early nuclear sclerosis, no ocular or nasal discharge HL: Normal thoracic auscultation INTEG: Dried blood staining around hind end MS: Ambulatory x 4, continues to have ventroflexion of cervical spine but improved from intake, less painful UG: Female, frank bloody vaginal discharge CBC/Chem results WNL except for mild lymphopenia and mildly elevated TP, globulins likely due to dental disease A: Appetite and cervical spinal pain improved — R/O inflammatory disease vs vs infectious vs trauma vs neoplasia vs other P: Continue supportive care, maintenance fluid LRS 26ml/hr, rimadyl 50mg PO q12 x 5 days. Scheduled radiographs. Consider advanced imaging with placement. Fair prognsois

Monitor condition S/O: Q/BARH. Allows all handling. Eager to go for walk today, walking well on harness. Urinated large amount, normal feces (appears house trained) EENT: Nuclear sclerosis, dental disease, pink mm, no ocular or nasal discharge, ears wnl HL: Normal thoracic auscultation, no coughing or sneezing ABD: Soft, non tender INTEG: Overgrown nails, dried blood on tail, no wounds or injuries noted MS: Ambulatory x 4, keeps head slightly low (cervical ventroflexion) on walk, more pronouned when handling/examining, stiff/resistent but appears less painful when manipulating neck up/down, left/right; BCS 3/9 UG: Female, bloody vaginal discharge A: Presented 11/2 underweight, anorexic, dehydrated with pronounced and painful cervical ventroflexion — anorexia and dehydration resolved, neck pain improving. NSF on blood work P: Continue to monitor while at BACC. Scheduled for cervical radiographs and nail trim today. Discontinue IVF today, eating and drinking well on own. Good prognosis with continued improvement

Progress exam-neck pain History: Intake 11/2 with severe neck pain. IVC placed and started on IVF and rimadyl. 11/3: had mild improvement of neck pain CBC/Chem results WNL except for mild lymphopenia and mildly elevated TP, globulins likely due to dental disease 11/4: pain continues to improve. IVF d/c. S/O: BARH. Eager to go for walk, walking well on harness. Normal urination, no bm. Normal TPR this morning. Seems to be slowly improving while in hospital. Will have rads of neck tomorrow. T=99.1 F P=116 bpm R=eupneic EENT: Nuclear sclerosis OU, mild dental disease, pink and moist mm, no ocular or nasal discharge, ears wnl HL: NMA, RR, Lungs C&E ABD: SNP, NMP MSI: Ambulatory x 4, keeps head slightly low (cervical ventroflexion) on walk, more pronounced when handling/examining, stiff/resistant and painful on mannipulation in all directions, also seems painful in cranial thoracic palpation, overgrown nails, dried blood around perineum from vulvar d/c UG: FI, no MGTs but developed mammary tissue with bloody/purulent d/c from nipples, bloody vaginal discharge A: Cervical pain with ventroflexion-improving Mastitis In heat Mild dental disease Hx aorexia-resolved Hx dehydration-resolved Underweight P: Continue to monitor while at BACC. Cervical radiographs tomorrow Trim nails tomorrow Continue rimadyl until 11/7-consider extending course Pulled IVC Start clavamox 13.75mg/kg PO BID x10d for mastitis until 11/15 Good prognosis with continued improvement

Progress exam-neck pain History: Intake 11/2 with severe neck pain. IVC placed and started on IVF and rimadyl. 11/3: had mild improvement of neck pain CBC/Chem results WNL except for mild lymphopenia and mildly elevated TP, globulins likely due to dental disease 11/4: pain continues to improve. IVF d/c. S/O: BARH. Eager to go for walk, walking well on harness. Holds head down and is very tense in the neck region. Seems to be slowly improving while in hospital. P=wnl R=eupneic EENT: Nuclear sclerosis OU, mild dental disease, pink and moist mm, no ocular or nasal discharge, ears wnl HL: NMA, RR, Lungs C&E ABD: SNP, NMP MSI: Ambulatory x 4, keeps head slightly low (cervical ventroflexion) on walk overgrown nails, dried blood around perineum from vulvar d/c UG: FI, no MGTs but developed mammary tissue, bloody vaginal discharge A: Fracture of the right side of the atlas through the body and wing Cervical pain with ventroflexion-improving Mastitis In heat Mild dental disease Hx aorexia-resolved Hx dehydration-resolved Underweight P: Continue to monitor while at BACC. Cervical radiographs-closed oblique fracture through the right side of the atlas through the wing and body of the vertebra Trim nails Continue rimadyl until 11/7-consider extending course Continue clavamox 13.75mg/kg PO BID for mastitis until 11/15 Good prognosis with continued improvement

Progress exam-neck pain History: Intake 11/2 with severe neck pain. IVC placed and started on IVF and rimadyl. 11/3: had mild improvement of neck pain CBC/Chem results WNL except for mild lymphopenia and mildly elevated TP, globulins likely due to dental disease 11/4: pain continues to improve. IVF d/c. S/O: BARH. Eager to go for walk, walking well on harness. Holds head down and is very tense in the neck region. Seems to be slowly improving while in hospital. P=wnl R=eupneic EENT: Nuclear sclerosis OU, mild dental disease, pink and moist mm, no ocular or nasal discharge, ears wnl HL: NMA, RR, Lungs C&E ABD: SNP, NMP MSI: Ambulatory x 4, keeps head slightly low (cervical ventroflexion) on walk overgrown nails, dried blood around perineum from vulvar d/c UG: FI, no MGTs but developed mammary tissue, bloody vaginal discharge A: Fracture of the right side of the atlas through the body and wing Cervical pain with ventroflexion-improving Mastitis In heat Mild dental disease Hx aorexia-resolved Hx dehydration-resolved Underweight P: Continue to monitor while at BACC. Cervical radiographs-closed oblique fracture through the right side of the atlas through the wing and body of the vertebra Trim nails Continue rimadyl until 11/7-consider extending course Continue clavamox 13.75mg/kg PO BID for mastitis until 11/15 Good prognosis with continued improvement

Progress exam-neck pain History: Intake 11/2 with severe neck pain. IVC placed and started on IVF and rimadyl. 11/3: had mild improvement of neck pain CBC/Chem results WNL except for mild lymphopenia and mildly elevated TP, globulins likely due to dental disease 11/6: Cervical radiographs-closed oblique fracture through the right side of the atlas through the wing and body of the vertebra 11/4: pain continues to improve. IVF d/c. S/O: BAR. No c/s/v/d. Excellent appetite. Resting comfortably in cage but neck is very tense and painful. Limited exam. EENT: Nuclear sclerosis OU, no ocular or nasal discharge HL: eupneic MSI: Ambulatory x 4, keeps head slightly low (cervical ventroflexion) on walks but is eager to go on walks UG: No more vulvar d/c noted on bedding-possibly no longer in heat A: Fracture of the right side of the atlas through the body and wing Cervical pain with ventroflexion-improving Mastitis In heat Mild dental disease Hx aorexia-resolved Hx dehydration-resolved Underweight P: Continue to monitor while at BACC. Extend rimadyl 4.4mg/kg PO SID until 11/14-consider extending course Start hydromorphone 0.1mg/kg IM BID x3d until 11/9 to see if neck pain improved Continue clavamox 13.75mg/kg PO BID for mastitis until 11/15 Harness walks only-no neck leads Good prognosis with continued improvement

Monitor neck pain History: Intake 11/2 with severe neck pain. IVC placed and started on IVF and rimadyl. 11/3: had mild improvement of neck pain CBC/Chem results WNL except for mild lymphopenia and mildly elevated TP, globulins likely due to dental disease 11/6: Cervical radiographs-closed oblique fracture through the right side of the atlas through the wing and body of the vertebra 11/4: pain continues to improve. IVF d/c. S/O: BARH. Eating well. Allows all handling. Attention seeking or resting comfortably in cage throughout day. EENT: Nuclear sclerosis OU, no ocular or nasal discharge HL: No coughing or sneezing MSI: Ambulatory x 4, keeps head slightly low (cervical ventroflexion) on walks but is eager to go on walks UG: Female, no discharge noted A: Fracture of the right side of the atlas through the body and wing; Cervical pain with ventroflexion-improving On treatment for mastitis Geriatric, mild dental disease P: Continue with current treatment and monitoring plan (rimadyl, hydromorphone, clavamox) Harness walks only-no neck leads Good prognosis with continued improvement **ADDENDUM 11/7 at 4:00pm-serous nasal d/c and sneezing noted on afternoon walk. doxycycline 10mg/kg PO SID x14d added to treatment plan by 1416

During intake Patches was crouched low to the floor and she did not want to walk. She allowed the counselor to take her picture with no problems.