4/02/2018

DVM Intake Exam Estimated age: 3-6 years based on dentition and overall appearance Microchip noted on Intake? Scanned negative on intake – MC placed during exam History : Stray, no health hx available Subjective: Alert, calm Observed Behavior – Walks easily on leash, allows all handling, relaxed body Evidence of Cruelty seen – None Evidence of Trauma seen – Mild alopecia and hyperpigmentation to ventral neck Objective BAR-H, MMs pink and moist, BCS 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Mild tartar PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: Female, developed nipples and vulva MSI: Ventral neck has a thick linear region of alopecia, hyperpigmentation, lichenification – approx 2-3 cm wide and 15-20 cm long. Ambulatory x 4, skin free of parasites, no masses noted, otherwise healthy hair coat. Tail docked. CNS: Mentation appropriate – no signs of neurologic abnormalities Rectal: Normal externally. Heartworm test – POSITIVE Assessment: 1. Heartworm positive! 2. Alopecia to ventral neck – consistent with collar being too tight 3. Dental disease Prognosis: Fair with prompt treatment of heartworm disease Plan: 1. Chest rads and CBC/chemistry 2. Doxycycline 10 mg/kg PO BID (TWICE daily) x30 days, followed by 1 dose of melarsomine, followed by 1 month of cage rest, followed by two doses of melarsomine 3. Recommend daily tooth brushing and regular dental cleanings 4. Do not leave playgroup collar on when not in use – the neck lesions will heal better if there is nothing on her neck SURGERY: TEMPORARY WAIVER from S/N surgery due to heartworm disease 1088

4/02/2018

SURGERY IS TEMPORARILY WAIVED FROM ACC DUE TO HEART WORM POSITIVE

6/02/2018

Heartworm positive on SNAP test at intake, microfilaria seen on blood smear on 2/5/18; blood work available for review CBC-mild eosinophilia Chemistry-mildly elevated ALT (169) Assessment-eosinophilia likely due to heartworm disease, unknown significance of mild ALT elevation but suspect benign or secondary (vaccination, HWD, other source of inflammation) over primary liver disease

6/02/2018

Lateral thoracic radiograph (unable to perform v/d without sedation)-inspiratory film, cardiac silhouette appears normal; moderate diffuse bronchiole pattern; cranial pulmonary vessels appear enlarged; orthopedic structures WNL; cranial abdomen partially in view and appears normal with ingesta in the stomach A -changes to lung field and pulmonary vessels likely associated with underlying heartworm disease P -recommend v/d radiograph (may need sedation) and ideally echocardiogram prior to immiticide treatment; however, unless worm burden is severe, findings may not change treatment plan -recommend following guidelines from American Heartworm Society, including prednisone administration and premedicating with diphenhydramine prior to administering first dose of heartworm preventative -doxycycline 200 mg PO SID x 4 weeks -prednisone 10 mg PO BID x 7 days, 10 mg SID x 7 days, 10 mg EOD x 2 weeks -administer advantage multi tomorrow -recommend first immiticide treatment in 60 days and then on day 90, 91

During intake Queen had a loose body inside the police carrier. She was a little hesitant to exit the carrier but after the counselor crouched to her level and spoke in a sweet tone she bounce right out. Outside the carrier she allowed her collar to be removed and replaced with an identity-band. She was receptive to handling and had a big appetite. She ate half a can of wet dog food.