Emergency Care Center at Tampa Bay Veterinary Specialists 1501A Belcher Road South, Suite 1A Largo, Florida

Transcription

1 Emergency Care Center at Tampa Bay Veterinary Specialists 1501A Belcher Road South, Suite 1A Largo, Florida Referring Veterinarian:Erin Morgan,Westlake Animal Hospital Client Information: Patient Information: Small Paws Rescue (#66813) Jackson 3316 South 72nd W. Ave Bichon Frise Tulsa, OK neutered male, 7 years Saturday, May 13, 2017 Presenting Complaint (4:21 pm Tiffany Gisel, DVM/TMG) P presented as rdvm transfer for evaluation of skin lesions and suspect pain/infection. Rescue organization director requested dermatology evaluation. Unknown exact cause of lesions but director suspect burn from heating pad during recent neuter. Medical History (4:27 pm Tiffany Gisel, DVM/TMG) Limited history due to shelter adoption. Home Environment: indoor and outdoor Current Medications:Apoquel, clindamycin, dex sp ophthalmic drops, meloxicam, tramadol Previous Medical History: recent neuter, skin lesions from suspect heating source during procedure (per director) Laboratory (4:49 pm Tiffany Gisel, DVM/AJG) Admitting lab values : PCV 40%, TP 7.2 g/dl. Blood glucose 92 mg/dl. Laboratory (4:55 pm Tiffany Gisel, DVM/)

2 Laboratory (5:24 pm Tiffany Gisel, DVM/)

3 Physical Examination (6:41 pm Tiffany Gisel, DVM/TMG) Temp:102.7F, Pulse:120bpm, Resp:56bpm, MM:pink, moist. Weight: kg, lb, 0.41 m2. Arterial BP (Cardell) - 190/156 (167). APPEARANCE: BAR, wagging tail. PAIN SCORE: 1 - slightly unsettled, mild reaction to palpation. NEURO: normal. BODY CONDITION SCORE: 3.25/5. MUSC/SKEL: normal. DERM: multiple skin lesions: 6cm dorsal thx with black center and red moist periphery, 2nd similar lesion 2cm axillary region, 3rd area 3cm healing crust over L hip surrounded by alopecia. EYES: moderate corneal edema OU, menace and PLR WNL, STT OS 20, OD 20, FSS negative OU, tonometry OD 26, OS 16 EARS: normal. NOSE: normal. ORAL: limited; muzzled, no rostral oral masses, small amount of calculus. CARD: III/VI L syst murmur, normal femoral pulse. RESP: normal respiratory effort and lung sounds. ABDOMEN: normal. UROGENITAL: normal. PERINEUM : normal. LYMPH: normal.

4 Client Communication (6:45 pm Tiffany Gisel, DVM/TMG) Discussed PE and hx with O. Recommended supportive care with evaluation for identified issues, specifically dermatology lesions, cardiac dz and ophthalmogy. Robin Pressnall (director for Small Paws Rescue) authorized treatment. Provided address: and phone number (918) Differential Diagnoses (6:46 pm Tiffany Gisel, DVM/TMG) corneal edema, cardiac dz, dermatological lesion Radiology (6:53 pm Tiffany Gisel, DVM/TMG) Number of images taken: Radiographic findings: moderate cardiomegaly, spondylosis mid lumbar, large amount of food in stomach, large urinary bladder, fecal material in colon. Radiologist review requested/pending. Radiology (6:54 pm Tiffany Gisel, DVM/dal) PetRays 2024 Rayford Road Spring, TX PETRAYS Requesting Facility: Gisel Veterinary Emergency Care Center Largo, FL Phone: Fax: Patient: Small Paws Rescue, Jackson Owner: Robin Study: Plain Film/X-Ray : 5 : Thorax, Abdomen Sex: Male, Neutered Age: 7y Weight: Species: Canine Breed: Bichon Frise Patient ID: History: skin lesions, cardiac mumur, uveitis Request Date: 05/13/17 6:22 pm Images Received: 05/13/17 6:25 pm Request Date: 05/13/17 6:22 pm RADIOGRAPHIC FINDINGS Orthogonal views of the thorax and abdomen are reviewed. A total of five views are submitted for interpretation. Thorax. The cardiac silhouette is of normal size with a vertebral heart score measurement of approximately Individual cardiac chamber enlargement is not identified. Pulmonary lobar vessels are normal to small in dimensions. A mild bronchial pattern is present within the pulmonary parenchyma. Soft tissue opaque pulmonary nodules, thoracic lymph node enlargement and fluid within the pleural cavity are not identified. There is asymmetry to the luminal diameter of the trachea. Esophageal dilation is not identified. Abdomen. Abdominal serosal margin detail is normal. The urinary bladder is moderately distended, is of uniform opacity with smooth margins. The prostate gland is enlarged with cranial extension beyond the pelvic inlet. The gastrointestinal tract is normal. Mixed soft tissue opaque material is present within the gastric lumen, consistent with food ingesta. The liver margins are rounded, however the overall size of the liver is normal. The spleen is obscured. Evaluation of the kidneys is limited by overlying intestinal structures.

5 Musculoskeletal. Intervertebral disc space narrowing with endplate sclerosis and ventral spondylosis deformans is present at multiple sites along the thoracic and lumbar vertebral column including T12-13 and L1-2. Bone production is present at the margins of the stifles. The stifles are at the edge of the imaging field-of-view. RADIOGRAPHIC CONCLUSIONS Prostatomegaly. Benign prostatic hyperplasia could be considered if the patient is intact, recently castrated or possibly has a retained testicle. Concurrent or other primary prostatic disease including prostatitis and neoplasia is not excluded. Urinary bladder distention could be related to delayed voiding. Other causes of urinary bladder distention including neuromuscular disease, atonic bladder and lower urinary tract obstruction is not excluded with clinical correlation warranted. Possible hepatopathy. Clinical correlation is warranted. The bronchial pattern is likely an age-related change. Lower airway disease remains a consideration. Left congestive heart failure is not identified. Degenerative changes of the thoracic and lumbar vertebral column. Degenerative joint disease of the stifles. If clinically warranted, abdominal ultrasound could be performed. Abdominal ultrasound will be of more diagnostic value if performed after fasting procedure. Bunita Eichelberger, DVM, MS, DACVR Treatment (6:55 pm Tiffany Gisel, DVM/TMG) provide food/water; eating well tramadol 25mg PO 12 clindamycin 92mg PO q 12 dex-sp drops OU q 12 Apoquel 4mg PO q 12 Sunday, May 14, 2017 Inpatient Assessment (6:53 am Patricia Anderson, DVM/PA) 5/14/2017 / 06:46 AM:Inpatient Daily Assessment: Jackson is BAR, MM:pink/moist CRT < 2 sec. H/L: grade 3/6 heart murmur, lungs clear. AP: comfortable. Neuro: appropriate. Skin: dorsal lesions unchanged. Eating and drinking normally. Normal eliminations. Continue supportive care- Tramadol 25mg PO 12 Clindamycin 92mg PO q 12 Dex-sp drops OU q 12 Apoquel 4mg PO q 12 Patricia Anderson, DVM Internal Medicine Consultation (9:09 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) Admitted by ECC service. Transferring to Internal Medicine service. Receiving hospitalized care for Tuesday, May 16, 2017 Inpatient Assessment (7:39 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO)

6 Continuing medical boarding care for multi-service rescue evaluations - Jackson has completed his medical/derm/ophtho assessment. He is bright, alert and eating well. OK to be returned to pdvm care while a foster home is arranged. Physical Examination (7:39 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) Weight: kg, lb, 0.41 m2 Temp: 100.7F, HR: 128/bpm, Resp: 30/min. Medical Treatment Plan (7:39 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) Inhospital patient treatment outline : - PO doxycycline 50mg dose BID - OU Dexamethasone 1% Ophtho Soln - 1 ggt TID - topical Silver-sulfadiazine applied to thermal burn wounds BID; begin to debride eschar PRN. Assessment (9:25 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) 1. Degenerative corneal disease, both eyes. 2. Dermatology issues : -> skin allergies, likely combination of inhalant allergy (atopy) and flea allergy dermatitis; recieved monthly flea treatment 05/ > dermal cyst over dorsal neck region - no treatment indicated at this time; cyst may rupture in future requiring local treatment. -> focal thermal burns over lateral thorax (left) and axillary region (right); forming well-defined mature eschar that will require serial debridement over time but expect these areas will heal with ongoing wound care. 3. Heart murmur; likely chronic degenerative valve disorder (mitral); stage B1; no appreciable heart enlargement on current chest xray so no further testing or therapy is necessary at this time; recommend monitor with serial xray every 6-12 months and followup with ECHO exam and initiate treatment if heart enlargement develops in future. 4. Intermittent dry hacking cough; associated with pulling on leash and excitement; suspect related to dynamic airway collapse of small breed dogs, however, considering his recent history he may have infectious "kennel cough". 5. Dental & peridontal disease; multiple tooth extractions 05/2017. Medical Treatment Plan (9:32 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) Medical plan at time of hospital release : - Doxycycline antibiotic 50mg dose by mouth twice daily for minimum 2 weeks; antibiotic effect will help with mild cough (if bacterial cause/ "kennel cough") and skin lesions; immunomodulating effect may help reduce corneal inflammation. - Sliver-sulfadiazine topical cream - apply to affected skin lesions on left body wall and right axillary region twice daily; reduces bacterial growth in healing skin wounds. - Dexamethasone Ophtho Solution - apply 1 drop to each eye every 8-12 hours for next 3-4 weeks. - Continue monthly heartworm and flea preventative treatment. - Continue atopy treatment of your choice (Apoquel, Cytopoint, etc...) as needed based on whether his allergy is seasonal vs. non-seasonal and whether clinical signs are mild or intense. Followup Recommendations (9:35 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) - He will require wound treatment 2-3 times weekly once the eschar begins to break down and requires serial debridement.

7 - He should have ophthalmology recheck examination in 3-4 weeks. - He should have recheck chest xray in 6 months. If he begins to cough regularly, exhibits exercise intolerance or develops labored breathing effort then he should be re-evaluated sooner. - He should have skin allergy rechecks as necessary depending on clinical signs. Meticulous flea control is necessary in his case. Pharmacy (11:20 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) Doxycycline 100mg tab #25 Give 1/2 tablet(s) by mouth twice daily. ANTIBIOTIC Silver-sulfadiazine 25gm #1 Apply thin layer topically directly to affected skin lesions twice daily. Written Communications (11:29 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/GPO) Tampa Bay Veterinary Internal Medicine PA Tampa Bay Veterinary Specialists 1501-A Belcher Road South, Suite 1A Largo, Florida Reception / EMERG MEDICAL RELEASE INFORMATION Date: Tuesday, May 16, 2017 Doctor: G. P. Oswald, DVM, Dip ACVIM (Int Med) Pet's Name: "Jackson" Small Paws Rescue, Canine Bichon Frise MC Referring Veterinarian : Dr. Erin Morgan, Westlake Animal Hospital, Tarpon Springs, FL. Diagnosis: 1. Degenerative corneal disease, both eyes. 2. Dermatology issues : -> skin allergies, likely combination of inhalant allergy (atopy) and flea allergy dermatitis; recieved monthly flea treatment 05/ > dermal cyst over dorsal neck region - no treatment indicated at this time; cyst may rupture in future requiring local treatment. -> focal thermal burns over lateral thorax (left) and axillary region (right); forming well-defined mature eschar that will require serial debridement over time but expect these areas will heal with ongoing wound care. 3. Heart murmur; likely chronic degenerative valve disorder (mitral); stage B1; no appreciable heart enlargement on current chest xray so no further testing or therapy is necessary at this time; recommend monitor with serial xray every 6-12 months and followup with ECHO exam and initiate treatment if heart enlargement develops in future. 4. Intermittent dry hacking cough; associated with pulling on leash and excitement; suspect related to dynamic airway collapse of small breed dogs, however, considering his recent history he may have infectious "kennel cough". 5. Dental & peridontal disease; multiple tooth extractions 05/2017.

8 Activity / Exercise: No restrictions on routine home activity. Diet: Continue feeding Jackson a standard canine adult diet. Current Medication Schedule: - Doxycycline antibiotic 50mg dose by mouth twice daily for 3 weeks; antibiotic effect will help with mild cough (if bacterial cause/ "kennel cough") and skin lesions; immunomodulating effect may help reduce corneal inflammation. - Dexamethasone 1% Ophtho Solution - apply 1 drop to each eye every 8-12 hours for next 3-4 weeks. - Continue monthly heartworm and flea preventative treatment. - Continue atopy treatment of your choice (Apoquel, Cytopoint, etc...) as needed based on whether his allergy is seasonal vs. non-seasonal and whether clinical signs are mild or intense. Thermal Wound Sites: Apply Sliver-sulfadiazine topical cream directly to and around the affected skin lesions (eschar) on left body wall and right axillary region twice daily; this will reduce bacterial growth in healing skin wounds. Keep the wounds clean and dry. You can gently wipe away any loose eschar fragments and debris from the wounds as needed. Your veterinarian will need to manage the wounds every few days and gradually trim away the dead eschar tissue and allow the healthy granulation tissue underneath to heal over time. Bath: You may bathe "Jackson" at any time. Followup Instructions: He should have ophthalmology recheck examination in 3-4 weeks to determine further treatment recommendations. He should have recheck chest xray in 6 months. If he begins to cough regularly, exhibits exercise intolerance or develops labored breathing effort then he should be re-evaluated sooner. He should have skin allergy rechecks as necessary depending on clinical signs. Meticulous flea control is necessary in his case. Please call if you have questions or problems. Invoice Summary (11:54 am G. P. Oswald, DVM, Dip ACVIM (Int Med)/BM) Details from Invoice # Hydrocodone/homatropine 5mg/1.5mg tabs