Intake 9/28-suspect HBC. S/O: QAR. Good appetite. Seems sedated with tramadol. Bandage is cdi EENT: Eyes clear, no ocular or nasal discharge HL: No sneezing MSI: Splint in place LHL-cdi. ambulatory x3 A: Fractured tibia and fibula LHL Degloving wound paw pad LHL-closed with PDS 9/28 Mildly elevated ALT P: CTM bandage daily-change on 10/3/17 or sooner if soiled Suture removal 10/10/17 Rec surgical repair of fractures Tramadol 2.5mg/kg PO BID Rimadyl 4.4mg/kg PO SID Good prognosis with surgical intervention.

Intake 9/28-suspect HBC. S/O: QAR. Good appetite. Seems sedated with tramadol. Bandage is cdi EENT: Eyes clear, no ocular or nasal discharge HL: No sneezing MSI: Splint in place LHL-cdi. ambulatory x3 A: Fractured tibia and fibula LHL Degloving wound paw pad LHL-closed with PDS 9/28 Mildly elevated ALT P: CTM bandage daily-change on 10/3/17 or sooner if soiled Suture removal 10/10/17 Rec surgical repair of fractures Tramadol 2.5mg/kg PO BID Rimadyl 4.4mg/kg PO SID Good prognosis with surgical intervention.

Intake 9/28-suspect HBC. Fractured LHL tibia and fibula. Soft padded bandage placed 9/28 and degloving of paw paw closed with PDS. Currently on tramadol and rimadyl S/O: QAR. Good appetite. Seems sedated with tramadol. Bandage is cdi. No c/s/v/d. Inquired as to why she did not have a lateral splint palced at intake and was told there were none available. Objective P = wnl R = eupneic BCS 5/9 EENT: Eyes clear, ears clean, no nasal discharge noted Oral Exam: clean adult dentition, no oral lesions noted PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 3 with LHL lameness and toe touching. Bandage cdi and when removed there was a 1cmx0.5cm abradion on the lateral stifle and crunching of the tibia and fibula palpated. She was very painful when the bandage was removed. The paw pad sutures and incicion were cdi with no d/c. Bruising on ventrum, skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate – no signs of neurologic abnormalities A: Fractured tibia and fibula LHL Degloving wound paw pad LHL-closed with PDS 9/28 Abrasion on lateral stifle Painful Mildly elevated ALT P: Removed soft padded bandage and placed lateral splint-tape stirrups-cotton padding-lateral splint-cotton padding-vet cling-vetwrap-elasticon around bottom Suture removal and bandage change on 10/10/17 Rec surgical repair of fractures ASAP-the older the fracture is the more difficult it will be to be repaired and may have to have amputation. Due to the fact she has not had splint stabilization the past week her fracture is not stable and she is still in pain. Hydromorphone 0.1mg/kg IM for splint change Tramadol 2.5mg/kg PO BID Rimadyl 4.4mg/kg PO SID Start clavamox 13.75mg/mg PO BID x14d Must be pilled-not taking oral medications Good prognosis with surgical intervention.

PPHX: Left Tibia/fibular fracture, possible HBC. S/O: Doing very well. Good appetite/attitude, appears to be comfortable on current medications. Lateral splint/bandage in good condition, clean dry, intact and stable. P: continue to monitor comfort and condition of splint/bandage. #1431

[Progress Exam Template] S: fx left tib fib 9/28/17 O: QARH mm pink EENT: clear AU , OU MSI: BCS 4/9 toe touching lameness LHL, hindquarter mmass slight atrophy . splint and bandage CDI Mentation: WNL A: fracture, loss of mmass report of possible open compound fracture per previous notes 10/4/17 P: seek placement, continue with current monitoring Is the Initial Medical Status being Changed? New Medical Status: Is the Initial Behavior Status being Changed? New Behavior Color:

Intake 9/28-suspect HBC. Fractured LHL tibia and fibula. Soft padded bandage placed 9/28 and degloving of paw paw closed with PDS. Currently on tramadol and rimadyl. Lateral splint placed 10/3 and clavamox added for possible open fracture S/O: QAR. Good appetite. Bandage is cdi. No c/s/v/d. Objective BCS 5/9 EENT: Eyes clear, no nasal discharge noted H/L: No c/s U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 3 with LHL lameness and toe touching. Bandage cdi. skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate – no signs of neurologic abnormalities A: Fractured tibia and fibula LHL Wound paw pad LHL-closed with PDS 9/28 Abrasion on lateral stifle Painful-resolved Mildly elevated ALT P: Suture removal and bandage change on 10/10/17 Rec surgical repair of fractures ASAP-the older the fracture is the more difficult it will be to be repaired and may have to have amputation. Ok to discontinue Tramadol 2.5mg/kg PO BID Continue clavamox 13.75mg/mg PO BID Good prognosis with surgical intervention.

Re-exam LFL tibia/fibula fx and new CIRDC History: Intake 9/28-suspect HBC. Fractured LHL tibia and fibula. Soft padded bandage placed 9/28 and degloving of paw paw closed with PDS. Currently on tramadol and rimadyl. Lateral splint placed 10/3 and clavamox added for possible open fracture S/O: QAR, ~5% dehydrated. Good appetite. Bandage is cdi. No v/d. Sneezing and coughing with purulent nasal d/c Objective BCS 5/9 EENT: Eyes clear, purulent nasal d/c bilaterally H/L: NMA, RR, Lungs C&E but coughing and sneezing U/G: FI, no MGTs, no vulvar d/c MSI: Ambulatory x 3 with LHL lameness and toe touching. Bandage cdi. skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate – no signs of neurologic abnormalities A: CIRDC Fractured tibia and fibula LHL Wound paw pad LHL-closed with PDS 9/28 Abrasion on lateral stifle Painful-resolved Mildly elevated ALT P: Start doxycycline 10mg/kg PO SID x10d until 10/17 LRS 20ml/kg SID x3d Move to iso if not being placed today Suture removal and bandage change on 10/10/17 Rec surgical repair of fractures ASAP-the older the fracture is the more difficult it will be to be repaired and may have to have amputation. Continue clavamox 13.75mg/mg PO BID Good prognosis with surgical intervention.

Re-exam LFL tibia/fibula fx and CIRDC History: Intake 9/28-suspect HBC. Fractured LHL tibia and fibula. Soft padded bandage placed 9/28 and degloving of paw paw closed with PDS. Currently on tramadol and rimadyl. Lateral splint placed 10/3 and clavamox added for possible open fracture. CIRDC diagnosed 10/7 S/O: BAR in kennel. Sitting up but not eager to stand. Bandage is cdi. No c/s/v/d. Objective BCS 5/9 EENT: Eyes clear, no nasal d/c H/L: No c/s MSI: sitting. Bandage cdi. skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate – no signs of neurologic abnormalities A: CIRDC Fractured tibia and fibula LHL Wound paw pad LHL-closed with PDS 9/28 Abrasion on lateral stifle Painful-resolved even without pain meds (pain meds ended tramadol 10/6 and rimadyl 10/4) Mildly elevated ALT P: Continue doxycycline 10mg/kg PO SID until 10/17 Continue LRS 20ml/kg SID x2d Iso Suture removal and bandage change on 10/10/17 Rec surgical repair of fractures ASAP-the older the fracture is the more difficult it will be to be repaired and may have to have amputation. Continue clavamox 13.75mg/mg PO BID until 10/17 Move to smaller kennel for exercise restriction Good prognosis with surgical intervention.

Re-exam LFL tibia/fibula fx and CIRDC History: Intake 9/28-suspect HBC. Fractured LHL tibia and fibula. Soft padded bandage placed 9/28 and degloving of paw paw closed with PDS. Currently on tramadol and rimadyl. Lateral splint placed 10/3 and clavamox added for possible open fracture. CIRDC diagnosed 10/7 S/O: BAR in kennel. Sitting up but not eager to stand. Bandage is cdi. No c/s/v/d. Objective BCS 5/9 EENT: Eyes clear, no nasal d/c H/L: No c/s MSI: sitting. Bandage cdi. skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate – no signs of neurologic abnormalities A: CIRDC Fractured tibia and fibula LHL Wound paw pad LHL-closed with PDS 9/28 Abrasion on lateral stifle Painful-resolved even without pain meds (pain meds ended tramadol 10/6 and rimadyl 10/4) Mildly elevated ALT P: Continue doxycycline 10mg/kg PO SID until 10/17 Continue LRS 20ml/kg SID 1 day Iso Suture removal and bandage change on 10/10/17 Rec surgical repair of fractures ASAP-the older the fracture is the more difficult it will be to be repaired and may have to have amputation. Continue clavamox 13.75mg/mg PO BID until 10/17 Move to smaller kennel for exercise restriction Good prognosis with surgical intervention.

Vet Notes Re-exam LFL tibia/fibula fx and CIRDC History: Intake 9/28-suspect HBC. Fractured LHL tibia and fibula. Soft padded bandage placed 9/28 and degloving of paw paw closed with PDS. Currently on tramadol and rimadyl. Lateral splint placed 10/3 and clavamox added for possible open fracture. CIRDC diagnosed 10/7 S/O: BAR in kennel. Sitting up but not eager to stand. Bandage is dirty and will be changed today. No c/s/v/d. Objective BCS 5/9 EENT: Eyes clear, no nasal d/c H/L: No c/s MSI: sitting. Bandage change. skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate – no signs of neurologic abnormalities A: CIRDC Fractured tibia and fibula LHL Wound paw pad LHL-closed with PDS 9/28 – s/r – some ulceration but clean and healing no purulent d/c, no odor Abrasion on lateral stifle Painful- overall seems comfortable, but will keep on rimadyl for next week’s check Mildly elevated ALT P: Continue doxycycline 10mg/kg PO SID until 10/17 Continue LRS 20ml/kg SID 1 day Iso restart carprofen bid w/ meals Suture removal and bandage change today Rec surgical repair of fractures ASAP-the older the fracture is the more difficult it will be to be repaired and may have to have amputation. Continue clavamox 13.75mg/mg PO BID until 10/17 Move to smaller kennel for exercise restriction Good prognosis with surgical intervention.