LADY – 16187
Safe - 12-19-2017 Brooklyn
SAFE 12/19/17 **FIV+ Kitten With URI / Not Eating Well NEEDS YOU ASAP! Little LADY at BACC!** Was Found In the Snow Last Night! @BACC
Brooklyn Center
FIV POSITIVE
Lady 16187, ~5 Months Old, Black and White DSH, Female, 1lb 11.2oz, Stray 12/15/17
Breed: Domestic Short HairThis animal came from:Found StrayOrigin AddressSpay/Neuter statusNoDate of Intake15-Dec-2017
Basic Information:Lady is a white and black kitten. She came to the center as a stray kitten.
Previously lived with:Unknown.
How is this cat around strangers?Lady is a stray kitten so her behavior is unknown.
How is this cat around children?Lady is a stray kitten so her behavior is unknown.
How is this cat around other cats?Lady is a stray kitten so her behavior is unknown.
How is this cat around dogs?Lady is a stray kitten so her behavior is unknown.
Behavior NotesLady is a stray kitten so her behavior is unknown.
Bite history:Lady is a stray kitten so her bite history is unknown.
Energy level/descriptors:Unknown.
Medical NotesLady is a stray kitten so her medical history is unknown.
For a New Family to KnowLady is a stray kitten so her behavior is unknown.
Behavior Notes:Lady was not handled during intake and was rushed to medical due to being very lethargic and cold to the touch.
ENRICHMENT NOTES:
12/17/17
Crouched in front of litterbox, body slightly tense. She tolerates petting along her head and body while lowering her head to the floor and squinting her eyes closed. Tail wraps around body. Uncomfortable with touch at this time. May be uncomfortable due to medical condition. Needs more time to adjust.
12/18/17
Crouched in back of kennel, body tense. She makes eye contact and tolerates petting along her head and body while tilting her ears and leaning her head away from my hand. Needs some more time to adjust. Sprayed feliway.
MEDICAL:
18-Dec-2017
Progress Exam
Vet Notes: 5:51 PM
[Progress Exam Template]
S:
P eating today and brighter than yesterday as per staff
O:
EENT: Crusty debris all over face from discharge +/- food
Oral Exam: Lingual ulcer appears improved, ucleration on mandibular lips lateral to lower k9 teeth present, food stuck in teeth and on lips
H/L: No m/a, eup
Abd: SNP
MSI: Amb x 4
Mentation:
A:
URI
FIV+
Hx of anorexia- improved
P: Continue current tx and monitor appetite etc
17-Dec-2017
Progress Exam
Vet Notes: 12:48 PM
[Progress Exam Template]
S: QAR, mild to mod prolonged skin turgor
O:
EENT:Mild to mod congestion, serous nasal discharge, mucoid ocular discharge, ears clear.
Oral Exam:somewhat limited as patient screamed/cried during exam. At level of 404, gingival defect with root exposure and ulceration/tissue defect at lip margin in that location. Rostral lingual ulcers/hyperemic; ptylism. L max quadrant, gingival defect and recession with root exposure at deciduous premolars. Max permanent canines erupted.
H/L: Not asculted
Abd:SNP, bladder small/soft, formed feces in colon
MSI:BCS 3/9, mod generalized muscle atrophy, ambx4
Mentation: Quiet
A:
5? m old F DSH
1. URI
2. Small stature, lean BCS especially given eruption of max canines
3. Oral lesions r/o severe ulceration secondary to infectious causes v juvenile periodontitis v traumatic v burn (electrical cord?) v other
4. Dehydration
P:
-Daily vet checks, monitor progression or oral lesions, hydration, comfort, app closely.
-Continue simbadol but at increased dose (0.24 mg/kg SID rather than 0.12 mg/kg SID), ideally add in additional analgesia given discomfort on exam
-Continue SQ LRS, doxy, erythro OO, other treatments
-Consider placement ASAP, may need dental in future
Is the Initial Medical Status being Changed?
New Medical Status: yes – oral lesions
Is the Initial Behavior Status being Changed?
New Behavior Color: no
VET-P 991374
16-Dec-2017
16-Dec-2017
Spay-Neuter Waiver Documentation
Vet Notes: 10:03 AM
[Spay/Neuter Waiver – Upper Respiratory Illness]
Your newly adopted animal is in treatment for an upper respiratory illness. The veterinarian is temporarily waiving this animal from the spay/neuter requirements of the City of NY until such time as the illness has resolved and the pet has sufficiently recovered. At that time, this animal must come into compliance with the spay/neuter requirements.
VET 990844
16-Dec-2017
Progress Exam
Vet Notes: 8:56 AM
Recheck kitten with severe URI
S/O: BAR. ~5-8% dehydration. Allows all handling. Shows some interest in food but not eating. Vocalizing. BCS 2/9
EENT: Moderate conjunctivitis OU, crusted mucoid nasal discharge, pink mm, adult dentition present, retained upper canines, no oral ulcers, thick saliva, crusted discharge around lower right lip
HL: Normal thoracic auscultation
ABD: Soft, non tender
INTEG: Unkempt
MS: Ambulatory x 4
UG: Female
A: Est 5-6months, severe URI, emaciated; tested FIV+
P: Continue with doxycycline, nutrical and LRS. Adding nebulization q24 x 3 days and simbadol 0.05ml SQ q24 x 3 days, erythromycin OU q12 x 7 days. Fair prognosis
VET 990844
15-Dec-2017
DVM Intake
Vet Notes: 5:48 PM
[DVM Intake]
DVM Intake Exam
Estimated age:3 m
Microchip noted on Intake? n
History : found in snow
Subjective:temp 91.4, dehydrated, emaciated, poss uri
Observed Behavior -qar
Evidence of Cruelty seen -n
Evidence of Trauma seen -n
Objective
T =
P =100
R =wnl
BCS1/9
EENT: Eyes sunked, ears clean, possible MPND
Oral Exam:
PLN: No enlargements noted
H/L: bradycardic, NMA, CRT < 2, Lungs clear, eupnic
ABD: Non painful, no masses palpated
U/G: female
MSI: Ambulatory x 4, skin free of parasites, no masses noted, wet fur
CNS: obtunded
Assessment uri, hypothermia, emaciated
Prognosis:guarded
Plan:
lrs sq gave 20 cc
nutrical po
heat support with bear hugger
parvo test neg
gave fvrcp, delayed other intake
doxy 0.15ml po
SURGERY:
Temporary waiver due to illness
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View all entries in: Safe Cats 2017-12