MARY – A1099001

BROOKLYN CENTER

MARY – A1099001

FEMALE, BLACK / TORBIE, DOMESTIC SH,8 mos
STRAY – STRAY WAIT, HOLD FOR DOH-B Reason STRAY
Intake condition INJ MINOR Intake Date 12/07/2016, From NY 11433, DueOut Date ,

Medical Behavior Evaluation RED
Medical Summary scanned nnegative sex:female age:approximately 8 months BARH Ear,eyes and nose is clear teeth:clean ear mites negative fleas negative lameness–on left hind leg(around the knee joint) abrasion,new wound, shaved and cleanned by chlorohex Dr. 1276 – did the x-ray not seen any broken nail trimed combo test-negative nervous,hissed and try to bite -sedated with 0.1 cc telazol as per 1163 NOSF
Weight 5.7

Initial Exam (12/07/16)

scanned negative

sex: female

age: approximately 8 months

BARH

Ears, eyes and nose is clear

teeth: clean

ear mites negative

fleas negative

lameness–on left hind leg(around the knee joint) abrasion, new wound, shaved and cleaned by chlorohex

Dr did the x-ray not seen any broken

nail trimmed

combo test-negative

nervous, hissed and try to bite -sedated with 0.1 cc telazol

NOSF

Re-Exam (12/07/16)

Check injured cat.

O: Sedated. mm=bright pink, moist, CRT<2 s.

ORAL: No oral lesions.

EENT: No oculonasal discharge.

H/L: HR=220, no murmurs/arrhythmias. Lungs clear.

ABD: Palpation WNL.

MS/INTEG: Left hind leg – mod soft tissue swelling from proximal tibia to proximal metatarsus. Erythema, abrasions and bleeding on lateral and medial tibia. No puncture wounds or lacerations found.

No other wounds identified. No palpable fractures or luxations.

A: Left hind limb soft tissue swelling and abrasions likely due to trauma. Per DOH memo – cat’s leg was caught between the slats of a fence.

P: Lat/AP radiographs of left hind: No visible fractures or luxations.

Buprenorphine S/R 0.11 ml SQ given.

Convenia 0.35 ml SQ given.

House in medical. Monitor lameness, appetite.

Excellent prognosis.

Re-Exam (12/08/16)

Recheck injured left hind leg, monitor appetite.

O: QAR. Hiding in back of cage, seems very fearful but not hissing or trying to strike. Ate overnight; has not eaten this AM.

EENT: No oculonasal discharge.

MS/INTEG: Amb x 4, mod left hind lameness. Mod. swelling distal tibia and tarsus.

A: Soft tissue injury left hind. Clinically stable.

P: Continue current therapy and monitoring.

Administer another dose of Buprenorphine S/R 0.11 ml SQ on 12/12/16.

Excellent prognosis.

Re-Exam (12/09/16)

Recheck injured LHL, monitor appetite

S/O: QAR. Retreated to back of cage, hissing. Did not attempt to handle. Eating with excellent appetite

MS/INTEG: Injury to distal LHL, swelling to metatarsals and digits, wound around hock

A: Injury to LHL, no fractures seen on radiographs 12/7

P: Continue with current treatment and monitoring plan. Stable condition. Good prognosis

Re-Exam (12/10/16)

Recheck injured LHL, monitor appetite

S/O: QAR. Hissing, does not allow handling. Eating with excellent appetite.

MS/INTEG: LH lameness, significant swelling to metatarsals and digits (increased from previous exam)

sedated with telazol 0.06ml IM to recheck left hind leg — crepitus and superficial wounds and extensive bruising around hock, no evidence of strangulating wound, no fractures seen on repeat radiographs

A: Injury to LHL limb (reported stuck in fence), significant swelling and bruising

P: Administered lasix 0.13ml IM to try to decrease swelling/edema of distal limb. Continue with current treatment and monitoring plan. Good prognosis

Re-Exam (12/12/16)

Recheck left hind leg.

O: QARH. Hissing, trying to hide.

MS/INTEG: Amb x 3, non-weight bearing left hind. Significant swelling of foot and metatarsus, skin erythematous, mild moisture (visual exam only-cat does not allow handling).

A: Foot injury secondary to strangulating wound. Edema persisting – r/o vascular or lymphatic injury.

P: Continue current therapy and monitoring.

Overall prognosis is good. Limb may require amputation if paw injury results in disuse or necrosis.

Rec. placement.

Re-Exam (12/14/16)

Recheck left hind leg.

O: QARH. Eating/drinking well. Hiding in back of cage. Allows brief exam but will try to flee.

MS/INTEG: Left hind leg still has marked swelling of metatarsus and foot, with erythema, moisture evident, and odor.

A: Left hind distal limb swelling post strangulation injury – not resolving. DDx: cellulitis, infection, vascular and/or lymphatic injury.

P: Was given Convenia on 12/07/16

Start Ciprofloxacin 250 mg/ml 0.1 ml PO q 24 hours x 10 days. (Gave first dose in food).

Continue to monitor while at BACC.

Re-Exam (12/19/16)

Recheck left hind leg.

O: QARH. Eating/drinking well. Hiding in back of cage, hisses when approached.

MS/INTEG: Left hind leg – marked swelling, erythema distal to tarsus. Open circumferential wound visible at tarsus, but cat won’t allow palpation or good exam.

A: Distal limb swelling unchanged, and new open wound developing.

P: Sedate in the AM for further evaluation, additional treatment.

Fair to good prognosis.

Re-Exam (12/20/16)

Sedation and recheck/treat left hind leg.

O: QAR. mm=pink, moist. Hissing. Administered Telazol 0.07 ml IM.

ORAL: Good dental condition, no oral lesions.

EENT: No nasal discharge.

H/L: HR=220, RR=12. Lungs clear, no murmurs/arrhythmias.

ABD: Palpation WNL.

MS/INTEG: Left hind limb – marked non-pitting edema from distal tibia to toes. Paw is warm, toes pink. Good femoral pulses, unable to palpate digital pulse due to degree of swelling. Just above area of swelling there is a circumferential area of necrotic, thickened skin which has constricted around the entire leg. This section of skin has pulled away from normal skin distal and proximal to it. No palpable fractures or luxations, all joints have normal ROM.

A: Peripheral limb edema due to skin necrosis and constriction of vascular/lymphatic vessels.

P: Sharply debrided necrotic skin/SQ tissue off with #10 blade. Ligament and tendon exposure caudally and medially, there is also an area of bone visible medially.

Assessment – deep wound. Distal limb may still be viable, but bone exposure is concerning. Ideal treatment options are daily wet-to-dry bandaging to allow granulation tissue to form (cat’s fractious nature may prohibit this unless sedated every day) vs amputation (would still require intensive management).

Administered Buprenorphine S/R 0.13 ml SQ.

Administered Convenia 80 mg/ml 0.35 ml SQ.

Fair to good prognosis.

Re-Exam (12/21/16)

Recheck left hind paw, wound.

O: BAR. Eating well. Hissing when approached.

MS/INTEG: Amb x 4 with severe lameness left hind. Wound at distal tibia clean and dry, no bleeding. Metatarsus/paw still markedly swollen.

A: Stable condition, no change in paw swelling.

P: Continue current therapy/monitoring.

Fair prognosis.

Re-Exam (12/22/16)

Monitor condition – open wound LH with paw swelling

S/O: BAR. Eating with excellent appetite. Normal urine and stool

EENT: Eyes clear, no ocular or nasal discharge

M/S: L metatarsus/paw still markedly swollen, may be very slightly improved since previous exams, wound appears dry, not bleeding

A: Soft tissue injury to LHL resulting in skin necrosis and constriction of circulation of distal limb

P: Continue with current treatment and monitoring plan. Fair/guarded prognosis

Re-Exam (12/23/16)

Monitor condition – open wound LH with paw swelling

S/O: QAR. Continues to eat with excellent appetite. Curled up in back of cage, unable to visualize leg

A: Soft tissue injury to LHL resulting in skin necrosis and constriction of circulation of distal limb

P: Continue with current treatment and monitoring plan. Fair/guarded prognosis

Re-Exam (12/28/16)

Recheck exam.

O: QARH. Eating/drinking well.

EENT: No oculonasal discharge or sneezing.

MS/INTEG: Cat allowed exam of leg with towel restraint: Circumferential wound over distal tibia is open, granulating, dry with no bleeding. Unable to visualize area where exposed bone was observed when tissue debrided on 12/20 – this area is covered by scabbing/dried tissue. Distal to wound, foot is moderately swollen, warm, erythematous. Mild moisture between toes dorsally. Cat will use limb to move away but does not stand on it.

A: Open wound and distal limb swelling due to constriction injury. Otherwise apparently healthy young cat.

P: Due for Buprenorphine S/R 0.11 ml SQ tonight.

Need to continue Ciprofloxacin 250 mg/ml 0.1 ml PO q 24 hours.

Convenia was given on 12/20/16.

Further therapy pending placement.

Good prognosis if hind limb amputation is pursued.

Re-Exam (12/29/16)

S/O: HX open wound at LH leg/tibia

– BARH – limited exam due to fractious behav.

– visualized the open wound ( ~ 2cm x 2cm) at left hind leg just above hock (about half way around) appears to be down to bone with marked swelling of left paw distal to wound, no bleeding/discharge

A: open wound, left hind leg

P: Continue ATBs; adding buprenorphine back to tx @ 0.15 mL OTM BID x 7d

px: fair/guarded prognosis – needs surgical treatment/amputation

Re-Exam (12/31/16)

s/o: visual exam dt behavior

eating well

dragging LHL, wound visualized during attempted exam

a:

rhl wound

p:

cwct

px: good with appropriate treatment

apparently comfortable on current treatment

Re-Exam (1/02/17)

s: unable to examine dt behavior, sedated with DKTB for exam and pharyngeal sample

o:

AU: WNL

OU: WNL

Oral: no lesions no dental tartar, adult dentition consistent with estimated age

Int: circumferential wound at LHL proximal to hock with approximately 1cm portion of cranial tibia exposed

Lnn: WNL

CV: NMA, s&s pulses, pink moist mm

Resp: lungs clear x4

Abd: SNP

Repro:

MS: 4x ambulatory, BCS 5/9

A:

circumferential wound at LHL proximal to hock with approximately 1cm portion of cranial tibia exposed

P:

bandaged LHL

0.1ml Buprenex SR SQ q3days

discont Buprenex OTM

discont cipro

start clavamox 0.8ml PO BID x7d

px: good with amputation

Re-Exam (1/03/17)

Unable to examine due to behavior – pt hissed and retreated multiple times. Pt appeared to have upper resp congestion today. Start doxycycline 0.5 ml PO SID x10 days.

Re-Exam (1/04/17)

Unable to examine today due to behavior. Continue tx – currently on doxycycline and amoxi/clav, as well as buprenorphine SR q3 days. Plan to amputate LHL tomorrow.

Pre/Post S/N (1/05/17)

EVALUATION OF LEFT HIND LIMB INJURY

PET SEDATED WITH TELAZOL, GIVEN MELOXICAM AND HYDRO PER WEIGHT CHART

PE UNDER SEDATION:

YOUNG HEALTHY INTACT FEMALE WITH LEFT HIND LIGATURE WOUND IN VARIOUS STAGES OF INFECTION, TIBIA EXPOSED ON CRANIOMEDIAL ASPECT, WITH DESICATED BONE AND MUSCLES. CAUDAL PART OF WOUND GRANULATION TISSUE PRESENT, SOME NRCROTIC MARGINS OF SKIN.

NORMAL THORACIC AUSCULTATION

PET WAS IV CATHETERIZED, START ON INTRAOPERATIVE FLUIDS AT 20ML/HR KETAMINE CRI 60MG/1L.

IN RIGHT LATERAL RECUMBENCY LEFT LIMB WAS AMPUTATED IN ROUTINE FASHION – DISARTICULATION COXOFEMORAL JOINT

COPIOUS FLUSHING WITH WARMED SALINE AND LIDOCAINE SPLASH BLOCK ( 0.6ML TOTAL USED) . THE SCIATIC NERVE WAS INJECTED PRIOR TO TRANSECTION.

SC TISSUES AND SKIN WAS CLOSED WITH SIMPLE INTERRUPTED AND CONTINUOUS 3-0 PDS PATTERN. NO EXPOSED SUTURES

AN ADDITIONAL DOSE OF HYDRO AT 0.025MG/KG WAS GIVEN AT EXTUBATION.

PLAN TO KEEP IV FLUIDS RUNNING AT 5ML/HR

ADD GABAPENTIN 20MG MICROTABS GIVE 1 TAB PO BID FOR 5 DAYS

CONTINUE WITH BUPRENORPHINE PO 0.2ML PO BD FOR 4 DAYS

REMOVE IV CATHETER N NEXT 1-2 DAYS

Re-Exam (1/06/17)

s/o:

IVC was unhooked this morning, no flow back in T port

hissing and trying to flee when approached, unable to examine

did brief exam in net

CV WNL, lungs clear

unable to palpate abdomen

LHL amp site clean dry and well apposed, minimal swelling

apparently comfortable in kennel

a:

LHL amputation

p;

cont with tx

px: good for amp site healing

Re-Exam (1/07/17)

s/o: visual exam only dt behavior

not eating overnight

amp closure site clean dry and well apposed with minimal swelling

no nasal dc, eupnic

a:

recovering post LHL amputation

URI (improving)

p:

0.25ml Mirtazapine PO

cwct

px: good

Re-Exam (1/08/17)

s/o

limited re-exam in towel

surgery site CDI, no redness, minimal swelling

cat is apparently comfortable on palpation of surgery site

BAR H

eating well and using litter box

no URI signs

a:

amputee

URI resolving

p:

cwct

switch to 0.1ml Buprenex SR (last of dose of Buprenex OTM this morning) SQ q3d

px: good

Re-Exam (1/09/17)

s/o: eating overnight, urinated outside box

no URI signs today

amp closure CDI, nonpainful on gentle palpation

a:

LHL amputation healing

URI resolved

p:

cwc pain management – Buprenex SR yesterday, next dose 1/11

discont Doxy

px: good

Behavior

The enrichment facilitator has been monitoring Mary and reports when she arrived she was very uncomfortable and stayed at the back of the kennel with her body lowered. She is nervous and has been displaying distance increasing behavior when attempting to interact with her.

Reaction to assessor: Mary was curled up tight on her blanket near the back of the kennel.

Reaction when softly spoken to: Mary lifts her head up slowly to make eye contact and doesn’t get up or come forward when coaxed.

Reaction to cage door opening: Mary remains motionless.

Reaction to touch: Mary hisses with her body lowered and her ears bent flat when the assessor approaches. She lip licks, tolerates petting with a slow gentle approach then slowly shifts away.

Please note that this cat is being treated for a medical condition at the time of evaluation. It is difficult to determine at this time how the medical condition may be affecting the behavior.

Behavior Determination: Experience No Child

Mary tolerates attention and petting but may be fearful or stressed in the shelter, and may be intimidated by small children. She may be a little more independent, and may need time to warm up to her new home. Due to the behaviors seen in the care center, we feel that this cat will do best in a calm, quiet home with experienced cat parents and without children.

Enrichment

12/09/16

Mary was pressed up against the back of the kennel with her body lowered. She backs away with wide eyes and hisses when approached. Responds well to tuna, devoured all of it. She was more receptive to touch after. With a slow approach she allows cheek and neck rubs. Sprayed feliway.

12/11/16

Pressed awkwardly into a rear corner, seems very uncomfortable. Didn’t moved but hissed when I approached. Not sure how much condition/treatment is affecting behavior. Didn’t show any interest in wet food or tuna when offered. Sprayed Feliway.

12/12/16

Hiding under paper and blanket, pressed alongside of cage. Quiet. With a slow approach, peeled cover back a little and started to pet her head gently, which she allowed, didn’t get up or try to avoid the touching. Gave some treats and wet food, sprayed Feliway.

12/13/16

Seems very uncomfortable, injured paw looks really swollen today and must be bothering her. At very back of kennel. Allowed some head rubs, but became uncomfortable with the touching quickly, wants to rest. Gave her a frozen tuna pop, some tuna and some wet food, not showing much interest in anything right now. Gave her a couple knitted blankets and left some Temptations treats.

12/14/16

Paw looks painful, she must be feeling awful. Allows me to give head rubs, stays at the very back, probably not easy to move a lot. Lets me know when she’s had enough petting. Gave her some fresh food and water. Really a beautiful young girl, distinctive markings.

12/15/16

Low body posture, but looks at the assessor with almond-shaped eyes when softly spoken to. She is hesitant of contact, but allows gentle petting with a very slow approach. Will flinch and hiss with any sudden noise or movement, but overall tolerant of petting.

12/18/16

Needs very slow and gentle approach. As usual is at very back of cage, looks uncomfortable. Hisses when I first approach, but then allows me to give head rubs. Was more interested in treats; gave her a bunch, and she was focused on those. Gave some more treats and some catnip.

12/19/16

Holding wounded paw up, looks like it’s really bothering her. At very back of cage, as usual. Gave a frozen tuna pop and a catnip toy and some Temptations treats.

12/28/16

At front of kennel, unusual. Allowed all petting, but uncomfortable. Got a good look at the injured hind leg, swelling seems to have gone down, but it’s in bad shape. Heartbreaking. Gave some treats and fresh water and food.

01/18/17

Facility Notes (Please note Mary was in group housing – the bolded section pertains to Mary)

(J-06) All the cats in this pod seem pretty fearful and stay hidden in separate hiding spots. Chinola warms up the fastest and slowly comes out when coaxed. She is very wary of her surroundings, constantly scanning her environment and relaxes a bit when pet. Mary and Ollie share a feral box together and usually stay curled up avoiding the other cats. They both are very nervous and display distance increasing behavior when approached. Squirrel keeps to herself; hidden inside a box and seems reluctant to come forward. She slow blinks and was a little hesitant when I extended my hand out but slowly warms up and leans in for more attention.

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