MINNIE – 31137
Safe - 7-5-2018 Brooklyn
SAFE 7/5/18 MINNIE needs your help finding her Mickey @ BACC *NEEDS FOLLOW UP MEDICAL CARE* 11 year old MINNIE was brought to the shelter with a large wound of unknown origin on the side of her neck. She also has a heart murmur. Minnie is friendly and affectionate and needs a new home where she can get lots of TLC and follow up vet care.
BROOKLYN CENTER
Minnie 31137
Care Center Location: Brooklyn
ZIP Code From: 11222
Intake Type: Stray
Medical Behavior: Green
Age: 11 years
Sex: Female
Weight: 8 lbs
Medical:
15-Jun-2018
Blood Work Interpretation
L V T Notes: 2:13 PM
6/15/18
PCV 23%
TS 1.048g/dl
serum clear
15-Jun-2018
Progress Exam
Vet Notes: 12:41 PM
H: Intake on 6/13. Noted to have large wound/ruptured mass on the dorsal/right lateral portion of the neck, a flocculent mass behind the left ear, an ulcerated area over the mammary gland and a heart murmur.
– Started on Clavamox and Simbadol
6/14- Wound debrided
Two view chest radiographs taken- ~16 x 17 mm circular lesion with a radio-opaque perimeter and radiolucent center (cavitated), ~12mm x 12mm circular radioopaque lesion – both lesions noted in the caudal right lung field. ~52 x 39mm radio-opaque lesion noted in the SQ space on the right side of the body, on the border of the thorax and abdomen. On the VD, there is also a 4x5mm radioopaque circular lesion noted immediately cranial to the other lesions. Mild bronchial pattern noted in caudal lung fields.
S: QARH. No csvd. Licked a small amount of food Formed stool and moderate urine in cage. Very affectionate and purring.
T 99.8F
P 200bpm
RR 30bpm
CRT: <2s. Gums: pale pink, moist
Eyes: Grossly appropriate OU.
Ears: Mild ceruminous debris AU
Nasal Cavity: No nasal discharge.
Oral Cavity: Mild to moderate dental tartar/periodontal disease.
PLN: WNL
Heart: Grade III systolic heart murmur ausculted. Pulses strong and synchronous.
Lungs: Eupneic. Mildly harsh lung sounds bilaterally.
Abd: Soft, non-painful. No palpable masses. No organomegaly appreciated.
U/G: Intact female (no spay scar). ~ 2-3cm in diameter ulcerated plaque-like lesion over area of right cranial mammary gland. Firm, small erythemic SQ mass felt over area of left caudal mammary gland. No discharge.
Musculoskeletal: Ambulatory x 4; RF paw mild to moderately swollen (IVC in place) and occasionally holds up
BCS = 6/9
Integument: Large ~ 6-7cm in diameter firm, ulcerated lesions spanning the dorsolateral portion (right) of the neck- moderate to severe crusting, purulent to caseous discharge. ~3-4cm in diameter flocculent mass noted immediately caudal to AS
Neuro: Appropriate mentation. Full neurologic exam not performed.
Rectal: Not performed. Externally normal.
Assessment
1) Multiple Skin masses (Ulcerated skin mass on neck, cystic skin mass on neck, plaque-like lesion over MG, firm nodule over MG)- There is concern the the last two are MGT, though it is unknown what the cause of the other two masses are. Also possible the latter are not MGT, but are in fact related to the other two masses. R/o skin diseases such as eosinophilic granuloma complex vs immune-mediated (ie erythema multiforme) vs neoplasia (MGT-adenocarcinoma vs other neoplasms such as lymphoma, hemangiosarcoma, fibrosarcoma, SCC).
2) Pulmonary infiltrates- The more cavitated lesion appears to either be a pulmonary bulla, pulmonary cyst or less likely bronchiectasis. The soft tissue lesion is concerning for a pulmonary mass (though cannot r/o granuloma vs abscess). In an older cat and given #1, high concern for neoplasia, though cannot r/o other causes such as infectious ( chronic interstitial pneumonia, Aelurostrongylus abstrusus (lungworms)) vs chronic asthma.
3) Heart Murmur- r/o heart disease (HCM) vs physiologic (DRVOTO)
4) Anemia- Mildly regenerative. As the regeneration is only mild, cannot completely r/o causes for non-regenerative anemia such as anemia of chronic disease/inflammation vs neoplasia vs less likely renal failure (given no evidence of azotemia). Top differentials for regenerative anemia in this case would be hemorrhage (due to presence of bleeding skin masses) vs infectious (mycoplasma haemofelis) vs IMHA (primary v secondary to neoplasia, vaccines, new medications).
5) Basophilia- With the basophils being elevated, cannot r/o a parasitic process (such as lungworms, given #2), however, eosinophils are normal. Would verify this with CBC sent out to outside lab + blood smear.
6) Hypokalemia (mild)- r/o renal loss (renal disease) vs GI loss (chronic GI disease) vs less likely transcellular shift vs normal variant
7) Hypoalbuminemia (mild)- r/o renal loss (renal disease, PLN) vs GI loss (chronic GI disease, PLE) vs negative acute phase response (due to excessive inflammation from #1-2), vs synthetic liver failure (less likely, however, BUN is also mildly decreased).
Cleaned open wound with sterile saline and chlorhexidine- remove significant amount of purulent discharge
Lanced flocculent mass on the left side of neck with #15 blade- expressed moderate amount of straw-colored fluid- flushed area with saline
CBC: Moderate anemia (Hct 20.3) minimally regenerative (Retic 60.5), Moderate to severe leukocytosis (39.71) with Neutrophilia (32.08), mild monocytosis (0.84) and basophilia (0.5)
Chemistry: Mild hypokalemia (3.3), mild hypoalbuminemia (2.0), mild elevation in GGT (5), mildly low BUN (14)
T4- normal
Prognosis: guarded to poor longterm
Plan:
Schedule fecal for tomorrow
d/c fluids- removed IVC
Continue Clavamox until 6/27, then reassess
Continue Simbadol until 6/16, then reassess
Repeat CBC on 6/17 + blood smear/saline
VET 991524
15-Jun-2018
14-Jun-2018
Progress Exam
Vet Notes: 4:01 PM
sedated exam for wound
Estimated age: 11
Evidence of Trauma seen – wound on neck most likely ruptured mass, not trauma
Objective BARH mm pink
rest of exam under sedation
P =WNL
R = WNL
BCS 6/9 fat pads however mild mmass atrophy
EENT: Eyes clear, ears mild waxy discharge, no nasal or ocular discharge noted
just caudal the left ear is a cystic mass approx 2 cm diam mass, SC, discreet, firm and mobile, needle aspiration yielded slightly opaque, straw colored fluid
behind right ear is 7 cm diam open wounds, purulent discharge, dried blood and various depths of granulation tissue
ventral neck appears normal
Oral Exam: adult dentition
PLN: No enlargements noted
H/L: NSR, III/VI sternal HM, CRT < 2, Lungs clear, eupnic
ABD: Non painful, no masses palpated
U/G:
MSI: Ambulatory x 4, skin free of parasites, several other ulcerated masses on right lateral trunk approx 2 cm area, and caudal ventrum
unclear if origin is MG tissue
healthy hair coat
CNS: Mentation appropriate – no signs of neurologic abnormalities
Rectal: not performed, visual normal
Assessment
multiple cutaneous ulcerated cystic and granulomatous masses r/o neoplasia vs fungal/other
heart murmur
lesions in radiographic view of thorax-open ddx
Prognosis:guarded
Plan:
two view whole body XR: right caudal lung fields: cystic/cavitated round lesion, and one solid round lesion approximately 1 cm diam each
cardiac silhouette and bronchial pattern normal for age.
Abdominal views good serosal detail, normal structures
Pet was intubated and maintained on isoflurane, LRS 50ml/hr intraoperative IV fluids through IV catheter right front.
Lidocaine injected SC around skin margins of rightsided head wound, 0.6ml total volume.
wounds were surgically debrided and cleaned with chlorhexidine and clean water
hairs were clipped from regions. FNA of left sided head mass removed most of fluid to deflate mass. Applied SSD to open ulcerated wound right side of head behind ear
Pet will be maintained on 10ml/hr until tomorrow’s assessment
retro virus negative
SURGERY:
continue with current tx
Permanent waiver due to masses, rec NH placement
VET 991204
13-Jun-2018
DVM Intake
Vet Notes: 6:28 PM
[DVM Intake]
DVM Intake Exam
Estimated age: approx 3 yo
Microchip noted on Intake? yes
Microchip Number (If Applicable): OA1O2E3A64
History : stray
Subjective: BAR. Readily popped head out of the carrier when opened. Curious, friendly, affectionate, purring, and well behaved during PE. No signs of aggression. Ate on own during PE.
Observed Behavior –
Evidence of Cruelty seen – n
Evidence of Trauma seen – n
Objective
T =
P = wnl
R = wnl
BCS 5/9
MM pink, slightly tacky, normal skin turgor
EENT: Eyes clear, ears clean, no nasal or ocular discharge noted
Oral Exam: p would not stay still for examination
PLN: No enlargements noted
H/L: Grade III/VI left systolic HM, NSR, CRT < 2, Lungs clear, eupnic. Difficult to auscultate due to purring.
ABD: Non painful, no masses palpated
U/G: F
MSI: Very large approx 7cm wound encompassing right dorsal/lateral neck and caudal right ear. Wound is deep, moist, ulcerated, with purulent discharge. Raised firm mass effect on caudal left ear base. Approx 3cm ulcerated wound on lower right thorax. Ambulatory x 4, skin free of parasites, fair hair coat
CNS: Mentation appropriate – no signs of neurologic abnormalities
Rectal: normal externally
Assessment
Wounds of unknown origin
HM
Prognosis: Fair
Plan:
Clavamox 1mL PO BID x 14 days
Simbadol 0.52 mL SQ SID x 5 days
monitor in medical
NPO overnight
Sedated wound treatment tomorrow
Verify spay status
Recommend cardiology work-up post placement
SURGERY:
Okay for surgery
Temporary waiver due to
Permanent waiver due to
VET-P 991459
Enrichment Notes:
06/14/18
Social and sweet. Comes forward immediately and greets by the door. Rubs up for attention, tail rises up. Appreciates attention. Allows petting all over. Didn’t mind being picked up/held. Doing great!
For more information on adopting from the NYC AC&C, or to find a rescue to assist, please read the following: http://urgentpodr.org/adoption-info-and-list-of-rescues. If you are local to the Tri-State, New England, and the general Northeast United States area, and you are SERIOUS about adopting or fostering one of the animals at NYC ACC, please read our MUST READ section for instructions, or email [email protected]. Our experienced volunteers will do their best to guide you through the process. * We highly discourage everyone from trusting strangers that send them Facebook messages, offering help, for it has ended in truly tragic events.* For more info on behavior codes and ratings, please click here: http://information.urgentpodr.org/acc-placement-status-descriptions. For answers to Frequently Asked Questions, please see: http://information.urgentpodr.org/category/frequently-asked-questions/. You can call (212) 788-4000 for automated instructions.
View all entries in: Safe Cats 2018-07