SADIE – A1043047

SADIE – A1043047

**RETURNED 09/28/2017**

SPAYED FEMALE, WHITE, MALTESE MIX, 8 yrs
OWNER SUR – EVALUATE, NO HOLD Reason COST
Intake condition EXAM REQ Intake Date 09/28/2017, From NY 10009, DueOut Date ,

Medical Behavior Evaluation GREEN
Medical Summary DVM Intake exam Estimated age: 8 years per surrendering owner Microchip noted on Intake? Scanned positive History : Last here in 2015. At that time, surrendering owner told us: “Sadie has crystals in her stomach that cause her to urinate frequently. She also has a skin condition, and recently had an ear infection.” Subjective: Calm, walks around Observed Behavior – Relaxed body, allows all handling Objective BAR, BCS 4/9, MMs pink and moist EENT: OD immature cataract. OU mucoid discharge caught in fur near eyes. Ears clean, no nasal discharge noted. Matted fur on face, ears, head. Oral Exam: Severe tartar, gingivitis PLN: No enlargements noted H/L: Grade 5/6 systolic heart murmur (with thrill), PMI left side. NSR. Lungs clear, eupnic ABD: Soft, non painful, no masses palpated U/G: Female, reported spayed, small vulva and mammary glands MSI: Alopecic on dorsum. Many mats all over body. Long nails. Ambulatory x 4, no masses noted. Good stifles. CNS: mentation appropriate – no signs of neurologic abnormalities Rectal: Normal externally Assessment 1. Severe heart murmur 2. Dorsal alopecia – R/O endocrine disorder, mats pulling at fur, thyroid disease, other 3. Cataract 4. Severe dental disease 5. Mats 6. Hx crystals and frequent urination Plan: 1. CBC/chemistry and chest/abd rads tomorrow – evaluate for heart disease and bladder stones while we’re at it 2. Grooming Prognosis: Fair 1088
Weight 10.6

 

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