BIRTHDAY – A1114589

Brooklyn Center

Birthday A1114589, 9 Weeks Old, Black and White DSH, Male, 2.1 lbs, Stray 06/07/17

Medical::

06/08/17:

DVM Intake Exam

Estimated age: 9w

Microchip noted on Intake? n

History: stray

Subjective:

Observed Behavior – hissing but allows handling

Evidence of Cruelty seen – n

Evidence of Trauma seen – n

Objective

P = 200 R = wnl BCS 5/9

EENT: Eyes clear, ears clean, no nasal discharge noted

Oral Exam: decid teeth

PLN: No enlargements noted

H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic

ABD: tense belly

U/G: male intact

MSI: Ambulatory x 4, skin free of parasites, no masses noted, dirty hair coat

CNS: mentation appropriate – no signs of neurologic abnormalities

Assessment: : healthy

Plan-neuter

Prognosis: good

SURGERY: Okay for surgery

06/09/17:

Pre-surgical exam

S/O: BAR. Hissing on approach

EENT: Eyes clear, no ocular or nasal discharge

HL: No sneezing

A: Apparently healthy

P: Based on chart review and no signs of URI, OK for surgery tomorrow

06/10/17:

Pre-surgical exam, anesthesia, and surgery performed by ASPCA.

Green linear tattoo placed on ventral abdomen.

Enrichment::

06/08/17:

At back of kennel, ears tilted. Hisses when spoken to. Tolerates petting while backing away and hissing. Needs more time to adjust. Sprayed feliway.

 

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