Airport Animal Hospital 4259 Haines Rd Duluth, MN (218) /10/2018. Gracie

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1 Blais, Scott Acct Number: Address...: Phone...: Cell Phone...: Patient ID: Swan Lake Rd Saginaw, MN H: (218) W:( ) - ext: ( ) - Gracie Medical Alert: Sex...: FS DOB...: 07/01/2007 Species..: Feline Chronic Meds...: Chronic Cond...: Flea Prev Meds...: [FLEA] Frontline+ F Heartworm Meds.: Weight.: 6.9lbs. Age...: 10 years and 6 months old Breed...: Dom. Shorthair Date Due: Date Due: Problem History: Status: Date Opened: Date Closed: Number: 01/09/ /09/2018 Please call owner with lab results - Note started in Infinity. Has owner received the transdermal methimazole from Roadrunner Pharmacy yet? mw Spoke with Scott about info in Infinity note, he is expected to receive the transdermal methimazole today, and set up the recheck for January 23rd at 2pm. ai/mw 01/08/2018 Note Lab Results & Client Communication Spec fpl - 3.5(0-3.5) Urine culture - No growth fpl, which is the indicator of pancreatitis is at the upper limit of normal. This would indicate that for right now, her pancreatitis is in remission and would not need treatment. The urine culture being ative is likely due to lack of growth at the lab, or a change in the bacteria during transport. As long as she is using her litter box, I would not recommend doing anything different at this time. Once owner has the transdermal methimazole, then he should schedule a recheck exam to assess Gracie's thyroid. This will determine if we need to alter dosage. HEALTHCHEK PLUS, CHEM 25 w/ SDMA, T4, CBC COMPREHENSIVE, SPEC fpl ADD- Requisition # Accession # HEALTHCHEK PLUS CHEM 25 w/ SDMA 01/06/ :15 AM ALP 91HIGH U/L ALT U/L AST U/L CREATINE KINASE 477HIGH U/L Page 1 of 19

2 GGT U/L ALBUMIN g/dl TOTAL PROTEIN g/dl GLOBULIN g/dl TOTAL BILIRUBIN mg/dl BILIRUBIN CONJUGATED < mg/dl BUN mg/dl CREATININE 0.6LOW mg/dl CHOLESTEROL mg/dl GLUCOSE mg/dl CALCIUM mg/dl PHOSPHORUS mg/dl TCO2 (BICARBONATE) mmol/l CHLORIDE mmol/l POTASSIUM mmol/l SODIUM mmol/l ALB/GLOB RATIO BUN/CREATININE RATIO 30 BILIRUBIN UNCONJUGATED mg/dl NA/K RATIO HEMOLYSIS INDEX LIPEMIA INDEX N Index of N, 1+, 2+ exhibits no significant effect on chemistry values. N Index of N, 1+, 2+ exhibits no significant effect on chemistry values. ANION GAP mmol/l SDMA ug/dl SDMA IS WITHIN THE REFERENCE INTERVAL AND CREATININE IS LOW which indicates kidney function is likely good. Evaluate a complete urinalysis and confirm there is no other evidence of kidney disease. T4 T4 12.3HIGH ug/dl Interpretive ranges:4.7 Consistent with hyperthyroidismcats with subnormal T4 values are almost exclusively euthyroid sick orovertreated for their hyperthyroidism. Older cats with consistentclinical signs and T4 values in the grey zone may have earlyhyperthyroidism or a concurrent non-thyroidal illness. Hyperthyroidismmay be confirmed in these cats by adding on a free T4 or by performinga T3 suppression test. Following treatment with methimazole, T4 valueswill generally fall within the lower end of the reference range( ). CBC COMPREHENSIVE WBC K/uL RBC M/uL Page 2 of 19

3 HGB g/dl HCT % MCV fl MCH pg MCHC g/dl % RETICULOCYTE 0.1 % RETICULOCYTE K/uL % NEUTROPHIL 57.8 % % LYMPHOCYTE 36.1 % % MONOCYTE 2.4 % % EOSINOPHIL 3.6 % % BASOPHIL 0.1 % PLATELET K/uL REMARKS SLIDE REVIEWED MICROSCOPICALLY.PLATELETS APPEAR ADEQUATE ON THE BLOOD FILM.PLATELETS ARE CLUMPED ON THE BLOOD FILM. NEUTROPHIL /ul LYMPHOCYTE /ul MONOCYTE /ul EOSINOPHIL /ul BASOPHIL /ul Requisition # Accession # Accession Comment SS PULLED FOR AO TC ON DARMS 12.55A HEALTHCHEK PLUS CHEM 25 w/ SDMA ALP 91HIGH U/L ALT U/L AST U/L CREATINE KINASE 477HIGH U/L GGT U/L ALBUMIN g/dl TOTAL PROTEIN g/dl GLOBULIN g/dl TOTAL BILIRUBIN mg/dl BILIRUBIN CONJUGATED < mg/dl BUN mg/dl Page 3 of 19

4 CREATININE 0.6LOW mg/dl CHOLESTEROL mg/dl GLUCOSE mg/dl CALCIUM mg/dl PHOSPHORUS mg/dl TCO2 (BICARBONATE) mmol/l CHLORIDE mmol/l POTASSIUM mmol/l SODIUM mmol/l ALB/GLOB RATIO BUN/CREATININE RATIO 30 BILIRUBIN UNCONJUGATED mg/dl NA/K RATIO HEMOLYSIS INDEX LIPEMIA INDEX N Index of N, 1+, 2+ exhibits no significant effect on chemistry values. N Index of N, 1+, 2+ exhibits no significant effect on chemistry values. ANION GAP mmol/l SDMA ug/dl SDMA IS WITHIN THE REFERENCE INTERVAL AND CREATININE IS LOW which indicates kidney function is likely good. Evaluate a complete urinalysis and confirm there is no other evidence of kidney disease. T4 T4 12.3HIGH ug/dl Interpretive ranges:4.7 Consistent with hyperthyroidismcats with subnormal T4 values are almost exclusively euthyroid sick orovertreated for their hyperthyroidism. Older cats with consistentclinical signs and T4 values in the grey zone may have earlyhyperthyroidism or a concurrent non-thyroidal illness. Hyperthyroidismmay be confirmed in these cats by adding on a free T4 or by performinga T3 suppression test. Following treatment with methimazole, T4 valueswill generally fall within the lower end of the reference range( ). CBC COMPREHENSIVE WBC K/uL RBC M/uL HGB g/dl HCT % MCV fl MCH pg MCHC g/dl % RETICULOCYTE 0.1 % RETICULOCYTE K/uL Page 4 of 19

5 % NEUTROPHIL 57.8 % % LYMPHOCYTE 36.1 % % MONOCYTE 2.4 % % EOSINOPHIL 3.6 % % BASOPHIL 0.1 % PLATELET K/uL REMARKS SLIDE REVIEWED MICROSCOPICALLY.PLATELETS APPEAR ADEQUATE ON THE BLOOD FILM.PLATELETS ARE CLUMPED ON THE BLOOD FILM. NEUTROPHIL /ul LYMPHOCYTE /ul MONOCYTE /ul EOSINOPHIL /ul BASOPHIL /ul SPEC fpl ADD-ON SPEC fpl ug/l Requisition # Accession # Accession Comment SOURCE: STATUS: WU FS FELINE URINE CULT & SUSCEPTIBILITY H URINE CULT & SUSCEPTIBILITY COMPLETED CULTURE RESULTS NO GROWTH URINE FINAL 01/06/ :19 AM 01/05/20 18 Dx Confirme d Hyperthyroidism 01/05/2018 Service fpl Spec Test referred add-on (24931) 01/05/2018 RX#: ml syringe 50mg/ml Methimazole QTY: 1.00 Filled By: (None) Apply 0.05ml to the hairless region of the inner pinna once daily until otherwise directed 01/05/ /05/2018 Expires On: Called Idexx and requested add on test for specfpl per MW. Test code was JE/mw Page 5 of 19

6 01/05/2018 Note Lab Results & Client Communication Chem panel - ALP 91(12-59), CK 477(64-440), Creat 0.6( ) CBC - WNL T4 12.3( ) Relayed results to owner. Advised urine C&S are still pending. All of Gracie's current signs may be related to hyperthyroidism. Plan to start on methimazole once daily and monitor for effect. Owner reports she is very difficult to give oral medication. Owner would like spec fpl run to assess for pancreatitis - called and added on this test. Called in script for transdermal methimazole to Roadrunner Pharmacy. Advised to call and let me know once she has started this medication - plan to recheck T4 and PCV 2 weeks after starting treatment, sooner if any problems noted. 01/05/ /05/2018 O called to check on lab work, reports cat continues to drink a lot of water. No vomiting. O will wait for call. jm/mw 01/04/2018 Service Convenia 80mg/mL injection QTY: /04/2018 Service Urine Culture & Sensitivity (4035) QTY: /04/2018 Service HealthChek+ Profile ccbc Chem tt4 (46) Collec Color Clar Cystocentesis Pale Yellow Cloudy SG ph 8 PRO 30 GLU KET UBG BIL BLD norm ph 8 PRO 30 GLU KET UBG BIL BLD norm UA Analyzer 01/04/ :43 AM QTY: /04/2018 Service Urinalysis In-hospital QTY: 1 01/04/2018 Service Exam & Consultation Level 2 QTY: 1 Page 6 of 19

7 01/04/2018 Service Weight QTY: 1 01/04/2018 SOAP Exam: PU/PD S: O husband brought in some notes: Seems to be sick like she was the same time last year with the dry cold air and below zero temps. Last year, days after treatment she got better and her drinking went up and went back to normal once it got warmer. O changed to a grain free diet thinking that it may be a factor. In the last few weeks her water intake has increased, around 9 trips to the water bowl per day but only goes to the litter box a couple of times. When she does urinate it is a very large amount. No accidents of urine or stool outside the litter box. No vomiting/diarrhea. Eating well but when she is done eating she will go lay down but almost seems uncomfortable, she will lay sternal almost crouched, per O lasts about 20 minutes. No meds/supps. Does go outside but follows husband out to the garage and that's about it. No coughing/sneezing. No nasal or eye discharge. Has a spot above her eye that was a tick bite a few years back but now it seems that it goes bald when she is not feeling well and then fills back in with hair when she feels better. Per husband he thinks she is little more lethargic, per wife, she thinks it is the weather. On O notes it says another snap test, kidney values and urine check. AM O: Gracie's Physical Examination Body Weight: 6.9 lbs. Body Condition: Gracie's body condition and weight are normal. There is the desired narrowing thru the abdomen and into the hips and waist and the ribs and spine are readily palpable. Ears: Both the ear canals and ear pinnas are normal. Gracie's tympanic membranes (ear drum) are normal and she seems to hear fine. Eyes: Gracie's eye(s) appear normal as do the eyelids and associated structures. Gracie appears to have normal vision. GI/Abdominal Palpation: Gracie's abdominal palpation is normal; there are no appreciable hernias, masses, fluid buildup, or pain. Heart/Cardiovascular: Gracie's heart is normal. The heart sounds are clear with no appreciable murmurs or arrhythmias heard and pulses palpate normally. Lungs/Trachea: Gracie's lungs sound normal with no fluid, crackles or wheezes. The trachea sounds and palpates normally as well. Lymph nodes/thyroid gland: Gracie's external lymph nodes (submandibular, pre-scapular, axillary and popliteal) all palpate normally. There are no abnormalities associated with the thyroid gland. Mouth/Teeth/Gums: The following abnormalities were found on Gracie's oral examination: There is mild calculus/tartar on the teeth. There is no visible Page 7 of 19

8 evidence of gingivitis, periodontal disease, or mobile teeth. Musculoskeletal: Gracie's muscles are in good condition and skeleton and joints are normal. There is no visible lameness or palpable pain and/or reduced range of motion noted. Nervous System: Gracie's nervous system is normal. There are no observable defects in the peripheral nerve, spinal cord or brain function. Nose/Throat: Gracie's nose and throat are normal. Air flows freely through nostrils and there is no discharge noted. There are no difficulties with vocalizing or swallowing. Skin/Haircoat: Gracie's haircoat and skin are normal. The fur is shiny with a soft texture. There are no signs of parasites or inflammation of the skin. Urinary/Reproductive: Gracie's urogenital and reproductive organs examined are normal. Other: PCV: 34%, TP: 6.8 g/dl Serum: Clear Bh UA - spec grav 1.032, ph 8.0, no RBC's or WBC's/hpf, TNTC Gram (+) cocci/hpf, 1-5 struvite crystals seen A: PU/PD UTI P: Admin 25mg(0.3ml) Convenia SQ Submitted urine for C&S to Idexx Submitted blood for HealthChek(CBC, Chem panel and T4) to Idexx Further treatment pending lab results 01/04/2018 Lab Value Temperature: = /04/2018 Lab Value Pulse: = /04/2018 Lab Value Respiration: = 64 12/27/ /27/2017 Scott rescheduled the appt for PU/PD today the 4th of January at 10: /bla/mw 08/08/2017 Service Pill Pocket Fel-Chicken QTY: /08/2017 Service Pill Pocket Fel-Salmon QTY: /14/2017 Service Ultrasound VIC single cavity QTY: 1 02/14/2017 Service Weight QTY: 1 Provider: Office Staff Provider: Office Staff 02/14/2017 SOAP Ultrasound S: Leslie reports that Gracie is doing much better. E/D normally. There has been no vomiting. Using the litter box very well. No c/s. No diarrhea. Her activity level is normal. No meds/supplements. No other concerns. Scott wanted Leslie to stay with Gracie and be apart of the Ultrasound if that was alright. AK Page 8 of 19

9 Owner commented that dose of Cerenia had sedation sideeffect for Gracie, so it was discontinued. mw O: Ultrasound Weight: 6.7# Ultrasound - all examined organs(liver, spleen, kidneys, stomach, pancreas, intestinal tract and bladder) appear normal A: Healthy P: No further treatment indicated at this time. 02/10/2017 Note Called o with stool results. Lmom. BH Provider: Elizabeth Hinnenkamp Requisition # Accession # Accession Comment FV FS FELINE FECAL DX PROF w/ GIARD FECAL DX PROF w/ GIARD E OVA & PARASITESNO OVA OR PARASITES GIARDIA ELISA WHIPWORM ELISA HOOKWORM ELISA ROUNDWORM ELISA NEGATIVE NEGATIVE NEGATIVE NEGATIVE 02/10/ :42 AM The IDEXX Fecal Dx antigen tests detect worm antigen and a positive indicates infection. Antigen-positive and egg-ative specimens can be seen during the pre-patent period, with single sex infections and due to intermittent egg shedding. Identification of eggs microscopically in antigen-ative specimens may be due to ingestion of infected feces (coprophagy) or because the amount of antigen is below the level of detection. Treatment should be considered for patients positive by either antigen or egg-detection. In cases of acute or chronic diarrhea also consider testing for viral, bacterial and protozoal infectious agents using RealPCR (canine diarrhea panel: test code 2625; feline diarrhea panel: test code 2627). 02/09/2017 Service Fecal Panel Comprehensive (24639) QTY: /06/2017 Service Pill Pocket Fel-Chicken QTY: /06/2017 Service Hill's PD i/d Feline 5.5oz can QTY: Provider: Office Staff Provider: Office Staff 02/06/2017 RX#: Hill's PD i/d Feline 5.5oz can QTY: Provider: Office Staff Expires On: 02/06/2017 Service RCanin Fel HypoHydroProtein 7.7# QTY: 1 Provider: Office Staff 02/06/2017 RX#: RCanin Fel HypoHydroProtein QTY: 1 Provider: Office Staff Expires On: 7.7# Page 9 of 19

10 02/02/ /02/2017 Scott is asking if he can come in with Gracie for an U/S on the 14th? He wants you to know she will not get away from them again. /bla Yes, please call Ralph to schedule. mw ***12:50pm called Dr. Ralph left message JM 02/01/ /01/2017 O is asking if we ran a glucose test with the urine test? /bla Yes, it was ative(no glucose in the urine). mw ***2:20pm called O with results. He reports yesterday cat was running around and very active, today she seems lethargic. Continues to eat well, scott said she seems to burp after eating, does not vomit and then lays down on her stomach. He plans to continue to monitor. Asked O if cat eats fast, he said not as fast as she used to but still sometimes it seems fast, briefly talked about presenting food on a plate or small amounts in a cupcake tin as an option, may slow her down, however, cautioned O we do not want to discourage cat from eating. jm/mw 01/31/ /31/2017 Gracie has hid in the house and they can't find her. /bla Please advise owner that if they find her in the next 2 hours, they can still bring her in for the ultrasound - please call and let us know. Or is she doing so well, that they want to cancel it for now? mw Called O, cancel with no plan to reschedule for now. Cat is doing better, was out on her leash yesterday for two hours, is eating fine. They know she is hiding in the rafters in the basement, took carrier out and cat bolted. O will continue to monitor and call if they have concerns. jm/mw 01/27/ /27/2017 O called, he reports cat still seems uncomfortable after eating (will lay down on stomach and "looks" uncomfortable) they just realized a possible exposure for cat, Leslie spilled gasoline on the garage floor one day, some boxes absorbed the gas, garage smells strong of gas. It is possible cat walked through the gas and groomed her feet. Scott said Gracie was doing well on Wednesday, did go in to garage that day and then condition worsened. JM/mw 01/26/ /26/2017 O called-yesterday Gracie was 100% she ate like a horse her energy was good, she was sleeping in her normal spot. This morning she ate breakfast and then started to not feel well, tried to defecate the first attempt nothing then the second attempt she had a formed stool, now crouching down seems painful. O said he hasn't given her Cerenia since Saturday. Rec: /bla 1/27/17 lethargic all night not wanting to eat this morning - O did give her a cerenia last night. O is interested in having an U/S next week. /bla/mw 01/25/2017 Service Rcanin Fe Hydro Prot 12 oz QTY: 1 01/25/2017 RX#: Rcanin Fe Hydro Prot 12 oz QTY: 1 Expires On: Feed 1/2 cup daily 01/25/2017 Service Cerenia 16 mg tab QTY: 4 Page 10 of 19

11 01/25/2017 RX#: Cerenia 16 mg tab QTY: 4 Expires On: Give 1/4 tablet orally once daily for nausea and abdominal pain 01/25/ /25/2017 Request from chewy.com for Royal Canin Diet Gastrointestinal Moderate Calorie Canned/24 count. In doctor's mail box. jm 1/25/17 10:10 O called and said to go ahead and set up the food you choose. /bla ***O called, he asked if he should pick up Cerenia, he reports Gracie seems to be uncomfortable/"painful" after eating. He has noticed cat will lay down immediatly after eating. Seems to move slowly after a meal, lay down slowly "as if painful". No V/D. After 10 minutes to an hour cat will get up and resume normal behavior. The episode of laying down slowly seems to happen more often later in the day after eating. jm Spoke with owner - Gracie seems back to normal activity and appetite. Primary concern is that she seems to lay down for awhile after eating as though her abdomen is uncomfortable. Plan to dispense additional Cerenia. Also discussed diet and plan to try the RC hydolyzed diet and see how she does. Advised that there is currently not a canned version of this food. mw 01/24/ /24/2017 Scott called and asked when we get a moment, he would like Gracie and Shadow's records e- mailed to him to have on hand. He almost had to take Gracie to e-clinic and felt having records of current labs would be benifical if either of them had to go in. His is crmfghtr@yahoo.com Thanks! DL 3:09 Sent to crmfghtr@yahoo.com /bla 01/24/ /24/2017 Owner called and was wondering about possible prescription diets for Gracie? She is eating right now but will still lay down after eating. He was wondering with the pancreatitis if there were rx diets that the DVM recommended? BH 1/25/17 LMOM for owner to call to discuss diet - rec feeding Royal Canin Hydrolyzed diet. mw 01/23/ /23/ Scott called with updates and questions for you on Gracie and Shadow and wanted to discuss Cerenia options. He said it was WAY too lengthy to leave as a message, despite me trying to pry info/exact questions out of him. He said they are ok he just has a lot to talk about. DL Spoke with owner. Cats may have drank water out of toilet that contained bowl cleaner. Advised any dilute bleach that may have been in water could certainly have caused GI upset. Rec that we continue with offering food and admin Cerenia and monitor their progress. Owner reports that Shadow ate great after getting home from receiving the Cerenia injection and has seemed normal in appetite since. Gracie is still not eating normally, but is starting to pick at food now. Plan to finish the course of Cerenia and can prescribe refill if improving but not completely back to normal. Plan to hold off on Prednisolone for now, as we seem to have an inciting cause. mw 01/20/ /20/2017 Shadow headed right to the food when she got home. He has given Gracie tap water and she is Page 11 of 19

12 loving it. Thank you! /bla/mw Are both Shadow and Gracie doing well - normal activity and eating well? no further vomiting? mw 1/23/17 LMOM to call with an update /bla 01/20/2017 Service Lean Treat Feline 3.5oz QTY: /20/2017 Service Cerenia injection QTY: /20/2017 Service Cerenia 16 mg tab QTY: 1 Provider: Office Staff 01/20/2017 RX#: Cerenia 16 mg tab QTY: 1 Expires On: Give 1/4 tablet orally once daily until otherwise directed - next dose is due tomorrow 1/21/17 01/20/2017 Service Weight QTY: 1 fpl Abnormal SNAP 01/20/ :19 PM 01/20/2017 Service fpl SNAP Test QTY: /20/2017 SOAP Not eating S: Gracie has only eaten about a tbsp of baby food in the last couple days, she seems interested and will lick gravy off of wet food. They have been feeding both cats purina proplan canned and have seen some reviews on BBB about other cats getting sick on this food. No more vomiting, they are unsure of stools but no urine/stool accidents out of box, she is a little bit lethargic. For the last couple months after Gracie would eat she seemed uncomfortable. Gracie does go outside but hasn't in a while and she doesn't roam, just go out for a little bit with client. O: Recheck Exam Weight: 6.6 pounds Exam is unchanged from last visit fpl - Abnormal A: Pancreatitis - r/o secondary to vomiting episode/overeating vs primary problem P: Admin 4mg Cerenia SQ Dispensed oral Cerenia to start Gracie on tomorrow If appetite does not improve, then need to re-evaluate treatment course 01/20/ /20/2017 O called (Scott) Gracie has not eaten for 3 days, Shadow has not eaten for 5 days... They will sniff food and walk away. O said he has tried a variety of food options. He thinks they are drinking water. Gracie slight decrease in activity, Shadow's activity appears normal. O asked for recommendations. JM Page 12 of 19

13 What type of foods has owner tried - canned, dry, baby food, lean chicken, favorite treat? He can try warming food to entice eating. If they have eaten nothing at all for 3-5 days, and he is unable to get them started with one of the above then they should be seen. mw 1/20/17 11:13 O has tried everything except baby food, and warming the food, they will lick the gravy out of the food but not eat it. Gracie did eat a teaspoon of food but she isn't feeling very well,he has tried 8 different cans of food. After Gracie eats she has to lay down for a bit on her side. If warming or babyfood doesn't work he will call to get them in. Gracie is a challange /bla/mw 01/18/2017 Service Convenia 80mg/mL injection QTY: 3.00 Catalyst Dx,UA Analyzer,ProCyte Dx 01/18/ :09 PM GLU 226HIGH mg/dl BUN mg/dl CREA mg/dl BUN/CREA 23 PHOS 2.9LOW mg/dl CA mg/dl TP g/dl ALB g/dl GLOB g/dl ALB/GLOB 0.9 ALT U/L ALKP U/L GGT U/L TBIL mg/dl CHOL mg/dl Na mmol/l K 3.3LOW mmol/l Na/K 46 Cl mmol/l Osm Calc 306 mmol/kg ph 7 PRO 100 GLU KET 15 UBG 4 BIL BLD 10 RBC M/µL HCT % HGB g/dl Page 13 of 19

14 MCV fl MCH pg MCHC g/dl RDW % %RETIC 0.1 % RETIC K/µL WBC %NEU 89.5 %LYM 8.3 %MONO 1.4 %EOS 0.1 %BASO 0.7 NEU LYM 1.28 MONO 0.22 EOS 0.02 BASO 0.11 PLT K/µL 01/18/2017 Service Urinalysis In-hospital QTY: 1 01/18/2017 Service Blood Chemistry 15 Catalyst QTY: /18/2017 Service CBC ProCyte QTY: 1 01/18/2017 Service Blood Chemistry Lytes 4 QTY: /18/2017 Service Senior Wellness Exam QTY: 1 01/18/2017 Service Weight QTY: 1 01/18/2017 SOAP Vomited yesterday S: Last night Gracie ate both her food and Shadow's food and 1 hour later started vomiting (4-5x within 1.5 hours) then this morning was acting very lethargic. Gracie has been happy/healthy up until this incidence. Not up to date on vaccines. Will let Scott decide about that when he comes at 2pm. KM O: Gracie's Physical Examination Body Weight: 6.6 lbs. Body Condition: Gracie's body condition and weight are normal. There is the desired narrowing thru the abdomen and into the hips and waist and the ribs and spine are readily palpable. Ears: Both the ear canals and ear pinnas are normal. Gracie's tympanic membranes (ear drum) are normal and she seems to hear fine. Page 14 of 19

15 Eyes: Gracie's eye(s) appear normal as do the eyelids and associated structures. Gracie appears to have normal vision. GI/Abdominal Palpation: Gracie's abdominal palpation is normal; there are no appreciable hernias, masses, fluid buildup, or pain. Heart/Cardiovascular: Gracie's heart is normal. The heart sounds are clear with no appreciable murmurs or arrhythmias heard and pulses palpate normally. Lungs/Trachea: Gracie's lungs sound normal with no fluid, crackles or wheezes. The trachea sounds and palpates normally as well. Lymph nodes/thyroid gland: Gracie's external lymph nodes (submandibular, pre-scapular, axillary and popliteal) all palpate normally. There are no abnormalities associated with the thyroid gland. Mouth/Teeth/Gums: The following abnormalities were found on Gracie's oral examination: There is mild calculus/tartar on the teeth. There is no visible evidence of gingivitis, periodontal disease, or mobile teeth. Musculoskeletal: Gracie's muscles are in good condition and skeleton and joints are normal. There is no visible lameness or palpable pain and/or reduced range of motion noted. Nervous System: Gracie's nervous system is normal. There are no observable defects in the peripheral nerve, spinal cord or brain function. Nose/Throat: Gracie's nose and throat are normal. Air flows freely through nostrils and there is no discharge noted. There are no difficulties with vocalizing or swallowing. Skin/Haircoat: Gracie's haircoat and skin are normal. The fur is shiny with a soft texture. There are no signs of parasites or inflammation of the skin. Urinary/Reproductive: Gracie's urogenital and reproductive organs examined are normal. Other: CBC - PCV 32%, WBC 15,510( ,020), Neutr 13,880 ( ,290) Chem panel - Phos 2.9( ), K 3.3( ) UA - spec grav >1.040, ph 7.0, 1-5 WBC's/hpf, Gram (+) cocci/hpf, no crystals seen A: Grade 1 periodontal disease UTI Anorexia/vomiting - r/o secondary to gastritis P: Admin 24mg Convenia SQ Rec monitoring for further vomiting - this may have been related to eating larger volume of food too fast. If vomiting continues or she is not eating normally, then recheck and consider testing fpl 01/18/20 17 Dx Confirme d Dental Calculi Page 15 of 19

16 01/18/20 17 Dx Confirme d Urinary Tract Infection 03/17/ /17/2016 How is Gracie doing - eyelid swelling resolved/improved? mw Called O for update, left message jm 03/18/ :15 pm O called back and said that the eye looks much better. Swelling is going down. Still not 100% better, but certainly headed in that direction. Thanked us for calling to check in. DC/mw 03/15/20 16 Dx Confirme d Tick Infestation 03/15/20 16 Dx Confirme d Eye Trauma 03/15/2016 Service Onsior 6 mg tablet QTY: /15/2016 RX#: Onsior 6 mg tablet QTY: 3.00 Expires On: Give 1 tablet orally once daily for 3 days - next dose is due tomorrow 3/16/16 03/15/2016 Service Convenia 80mg/mL injection QTY: /15/2016 Service Exam & Consultation Level 2 QTY: 1 03/15/2016 Service Weight QTY: 1 03/15/2016 SOAP Check bump - above left eye S: Noticed lump above left eye about 4-5 days ago, was just a small red scabby area at first, noticed it was very large yesterday. There is some purulent discharge noted, does not seem to bother gracie - no squinting/rubbing, eating/drinking normally, no vomiting/diarrhea, using litter box normally, activity level normal. O: Gracie's Physical Examination Body Weight: 6.9 lbs. Body Condition: Gracie's body condition and weight are normal. There is the desired narrowing thru the abdomen and into the hips and waist and the ribs and spine are readily palpable. Ears: Both the ear canals and ear pinnas are normal. Gracie's tympanic membranes (ear drum) are normal and she seems to hear fine. Eyes: The following abnormalities were seen in the eye(s): Page 16 of 19

17 The left upper eyelid is swollen and erythematous. There is a deer tick protruding from the center of the lesion. Gracie's eye(s) appear otherwise normal as do the eyelids and associated structures. Gracie appears to have normal vision. GI/Abdominal Palpation: Gracie's abdominal palpation is normal; there are no appreciable hernias, masses, fluid buildup, or pain. Heart/Cardiovascular: Gracie's heart is normal. The heart sounds are clear with no appreciable murmurs or arrhythmias heard and pulses palpate normally. Lungs/Trachea: Gracie's lungs sound normal with no fluid, crackles or wheezes. The trachea sounds and palpates normally as well. Lymph nodes/thyroid gland: Gracie's external lymph nodes (submandibular, pre-scapular, axillary and popliteal) all palpate normally. There are no abnormalities associated with the thyroid gland. Mouth/Teeth/Gums: Gracie's oral examination is normal. There is no evidence of tartar accumulation or changes to the enamel of the teeth. There is no visible evidence of gingivitis, periodontal disease, or mobile teeth. Musculoskeletal: Gracie's muscles are in good condition and skeleton and joints are normal. There is no visible lameness or palpable pain and/or reduced range of motion noted. Nervous System: Gracie's nervous system is normal. There are no observable defects in the peripheral nerve, spinal cord or brain function. Nose/Throat: Gracie's nose and throat are normal. Air flows freely through nostrils and there is no discharge noted. There are no difficulties with vocalizing or swallowing. Skin/Haircoat: Gracie's haircoat and skin are normal. The fur is shiny with a soft texture. There are no signs of parasites or inflammation of the skin. Urinary/Reproductive: Gracie's urogenital and reproductive organs examined are normal. Other: Removed tick with hemostat, cleaned area well and compressed Admin 25mg Convenia SQ A: Eyelid swelling secondary to tick attachment P: Dispensed Onsior - 1st dose given in exam room Rec updating vaccinations - Gracie is past due Rec apply warm/moist compress to eyelid for minutes, 2-3 times per day until swelling has resolved Recheck if worsens or does not resolve 08/05/2015 Note Called O w/fecal results Provider: Dr. Christine Wickenheiser Page 17 of 19

18 Requisition # Accession # Accession Comment fv FS FELINE FECAL PANEL COMP E OVA & PARASITESNO OVA OR PARASITES GIARDIA ELISA WHIPWORM ELISA HOOKWORM ELISA ROUNDWORM ELISA NEGATIVE NEGATIVE NEGATIVE NEGATIVE FECAL PANEL COMP 08/05/ :40 AM In cases of acute or chronic diarrhea in addition to a fecalfloatation and antigen testing for ova and parasites consider testing for viral, bacterial and protozoal infectious agents using RealPCR(canine diarrhea panel: test code 2625; feline diarrhea panel: testcode 2627). 08/04/2015 Service Fecal Panel Comprehensive (24639) QTY: 1 08/04/2015 Service Nail Trim QTY: 1 08/04/2015 Service Exam/Consultation Level 1 Wellness QTY: 1 Provider: Dr. Christine Wickenheiser Provider: Dr. Christine Wickenheiser Provider: Dr. Christine Wickenheiser 08/04/2015 SOAP Lethargic/twitching Provider: Dr. Christine Wickenheiser S: Gracie was lethargic for a couple days, seems more normal yesterday and today. Also noticed for the last couple weeks that she will be running than stop quick and start biting at herself and has a twitch near tail. Does got outdoors but only on leash with owner. Eating drinking normally, no vomiting/diarrhea, using litter box normally, no coughing/sneezing, not on any medication. O: A: P: 04/27/2012 Service Weight QTY: 1 04/27/2012 Cert Rabies Certificate 04/27/2012 Service PureVax RCCP & Rabies 1yr QTY: 1 04/27/2012 Service Wellness Exam/Consultation QTY: 1 07/08/2009 Converted [RXFOOD] IVET FELINE ADULT 3.5# 07/08/2009 Converted [FLEA] Frontline+ Feline 6ct 01/16/2009 Converted [RXF] Disp: Clavamox Drops 15cc Provider: Dr. Leslie Clapper-Rentz Provider: Dr. Leslie Clapper-Rentz Provider: Dr. Leslie Clapper-Rentz Provider: Office Provider: Office Provider: P Fitzgerald Page 18 of 19

19 01/16/2009 Converted [EXP] Exam/Consult-Level 2 01/16/2009 Converted [HOSP12] Hosp Care-Half Day 01/16/2009 Converted [SED] Sedation 01/16/2009 Converted [RXF] Disp: Buprenorphine 0.3 mg/m 01/16/2009 Converted [OEX] Oropharyngeal Foreign Body 01/16/2009 Converted [RAD1] Radiograph First 01/16/2009 Converted [RAD2] Radiograph Second 10/10/2008 Converted [RXL] Disp: Buprenorphine 0.3 mg/m 10/10/2008 Converted [NTC] Courtesy Nail Trim 10/10/2008 Converted [OHESPC] Spay Certificate for OHE 10/10/2008 Converted [FOHE] Feline Ovariohysterectomy 10/10/2008 Converted [IVFLU] IV Fluids-Elective Surgery 10/10/2008 Converted [OTC] E Collar 12cm (3M) 10/10/2008 Converted [PAINM] Narcotic analgesia (multi) 09/15/2008 Converted [EXPV] Wellness Exam/Consultation 09/15/2008 Converted [RCCP] Felocell 4 RCCP annual 08/18/2008 Converted [EXPV] Wellness Exam/Consultation 08/18/2008 Converted [==FEL] SQ MERIAL PUREVAX KV 08/18/2008 Converted [RCPFRT] PureVax RCCP(temp)+Rabies Provider: P Fitzgerald Provider: P Fitzgerald Provider: P Fitzgerald Provider: P Fitzgerald Provider: P Fitzgerald Provider: P Fitzgerald Provider: P Fitzgerald Provider: C Wickenheiser Provider: C Wickenheiser Provider: C Wickenheiser Provider: C Wickenheiser Provider: C Wickenheiser Provider: C Wickenheiser Provider: C Wickenheiser Provider: L Clapper-Rent Provider: L Clapper-Rent Provider: L Clapper-Rent Provider: L Clapper-Rent Provider: L Clapper-Rent For any questions on Gracie's health, please call. Page 19 of 19