PEACH PUFF – 22410
Safe - 3-14-2018 Manhattan
SAFE 3/14/18 **POLYDACTYL** 8 YEAR OLD PEACH PUFF was brought in with ear issues, imbedded nails and needs a home with some follow up care.
MANHATTAN CENTER
Peach Puff 22410
Location: Manhattan
Intake Date: 3/8/18
Intake Type: Stray
Medical Behavior: Blue
Sex: Male
Age: 8 years
Original Location: 11374
DVM Intake Exam
Estimated age: 4yo
Microchip noted on Intake? neg
Microchip Number (If Applicable):
History : stray. Arrived with AU ear disease, embedded nails, and dehydration. LVT treatments done — nails were clipped and feet soaked in nolvasan. Ear were cleaned. SQ LRS given. SQ ivermectin given.
Subjective:
Observed Behavior –
Evidence of Cruelty seen – n
Evidence of Trauma seen – n
Objective
T =
P = wnl
R = wnl
BCS 4/9
MM pink and moist, normal skin turgor
EENT: Eyes clear, no nasal or ocular discharge noted. AD purulent discharge with some blood, polyp within canal. AS black/brown debris.
Oral Exam: mild staining and gingivitis
PLN: No enlargements noted
H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic
ABD: Non painful, no masses palpated
U/G: MI, 2 testicles
MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat. Polydactyl. No signs of injury on paw pads from previously reported embedded nails.
CNS: Mentation appropriate – no signs of neurologic abnormalities
Rectal: normal externally
Assessment
AD polyp
otitis externa
Prognosis: good
Plan:
cleaned ears
removed AD polyp with hemostats, patient was very well behaved and did not need sedation. Ear bled, bleeding controlled with pressure and applied silver nitrate sticks. If ear does not improve, p may needed sedated exam to see if polyp still remains.
tresaderm AU BID x 7 days
clavamox 1mL PO BID x 7 days
simbadol 0.5mL SQ once
SURGERY:
Okay for surgery
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View all entries in: Safe Cats 2018-03