Veterinary Emergency & Specialty Hospital of Wichita

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1 Veterinary Emergency & Specialty Hospital of Wichita 727 South Washington Wichita, KS (316) Medical Record for Bingo Brandt Client Information: Victor Brandt (#67217) 3540 N Ridgewood St Wichita, KS (936) (Home) (Cell) Patient Information: "Bingo" (#89946) Canine, English Cocker Spaniel Male, Red Age: 12 year(s) Weight: Ibs Primary Veterinarian: Dr. Johnson, Willowbend Animal Hospital Monday, February 20, 2017 Veterinary Communications (7:28 pm Doctor unknown/cot) Bingo Brandt lab PD PDF Veterinary Communications (7:29 pm Stephen Ward, DVM/COT) Bingo Brandt UA PD PDF Veterinary Communications (7:29 pm Doctor unknown/cot) Bingo Brandt lab 2 PD PDF Veterinary Communications (7:29 pm Doctor unknown/cot) Bingo Brandt referral PD PDF Assessment (7:32 pm Stephen Ward, DVM/CND) 2/20/2017,07:32 PM Bingo presented to Veterinary Emergency and Specialty Hospital of Wichita on Monday, February 20, 2017 at 07:32 PM with the following complaint: Presenting Complaint (7:33 pm Stephen Ward, DVM/CND) Bingo presented as a transfer from RDVM, renal failure patient, not doing well the last few days. Assessment (7:34 pm Stephen Ward, DVM/CND) Age: 12 year(s) 6 month(s) Weight: kg, Ib Vaccinations are current ALLERGIES: NONE NOTED MEDICATIONS CURRENTLY ON: ampicillin, baytril Vitals: Temp= F; HR= 170/min; Pulse Quality= adequate; Resp= 40/min; MM= light pink; CRT= 1.5 seconds History (8:00 pm Stephen Ward, DVM/SCW) see presenting Physical Examination (8:00 pm Stephen Ward, DVM/SCW) Appearance: depressed Eyes: lens sclerosis Ears: not examined at this time Nose: NSF Oral Cavity: periodontitis Heart 1 Lungs: Grade III-IVNI murmur, lungs: Mildly harsh, no crackles Abdomen: NSF Musculoskeletal: NSF Neurological: NSF Skin: NSF Lymph Nodes: NSF

2 G/U: Right testicular enlargement with atrophied left testicle "-Rectal: NIA Hydration: 5-6% Dehydrated Diagnosis (8:00 pm Stephen Ward, DVM/SeW) Tentative Diagnosis: pylonephritis? pneumonia (per rdvm) Prognosis fair (8:00 pm Stephen Ward, DVM/SeW) Recommendations (8:00 pm Stephen Ward, DVM/SeW) Hospitalize, IV Fluids, laboratory, antibiotics, antiemetics, antacids Treatments (10:27 pm Stephen Ward, DVM/MS) Started on liter of 0.9% Sodium Chloride T-port used in setup. Patient Monitoring (10:27 pm Stephen Ward, DVM/MS) Fluids started at 60 mllhr Medications (10:28 pm Stephen Ward, DVM/MS) 300 mg Ampicillin inj (30mg/ml) IV 5.4 ml Baytril inj (22.7mg/ml) IV diluted 1:1 with Saline 7 mg Famotidine Inj (10mg/ml) IV Slowly 13 mg Cerenia injection (1Omg/ml) IV slowly Radiographic Interpretation 2/20/2017, 11:42 PM Bingo Brandt Patient 10: (11:42 pm Stephen Ward, DVM/AML) Findings Thoracic and abdominal radiographs dated 02/20/2017 are available for review. No significant intrathoracic abnormalities are identified. The cardiac silhouette, pulmonary vasculature, and pulmonary parenchyma are within normal limits. There are no focal pulmonary infiltrates or pulmonary nodules. The trachea and cranial mediastinum are normal. There is no evidence for pleural effusion. There is an identification chip in the soft tissues dorsal to the thoracic spine. Abdominal serosal detail is decreased. This is most pronounced in the cranial to mid abdominal cavity. The kidneys are small. The prostate is moderately enlarged. The cranial margin of the prostate is mildly irregular. There is spondylosis at the lumbosacral junction. Conclusion The loss abdominal serosal detail is consistent with an accumulation of free fluid, peritonitis secondary to pancreatitis or other causes, or carcinomatosis. The possibility for an underlying intra-abdominal mass and/or lymphadenopathy cannot be excluded. There is moderate prostatomegaly. This may be associated with benign prostatic hypertrophy, prostatitis, abscess, or neoplasia. The small kidneys are consistent with chronic renal degeneration. Unremarkable thorax, there is no evidence for pulmonary metastatic disease or intrathoracic lymphadenopathy. Recommendations Abdominal ultrasound and abdominocentesis for fluid analysis and cytology are recommended for further evaluation. Read By: Todd Henrikson DVM, DACVR Tuesday, February 21, 2017 Patient Monitoring (12:00 am Stephen Ward, DVM/MS) Time of TPR: 12am Temp= F; HR= 120/min; Pulse Quality= strong; Resp= 20/min; MM= pink; CRT= 1.5 seconds Total volume of IV fluids administered at this time is 178 mls. Fluid rate is 60 mls per hour. Pain Score = 1/10 Reasoning: n/a

3 'Offered-water. No interest. Bingo did not want to walk outside this hour. Did not disturb him since he is resting well. Client Communications (12:59 am Stephen Ward, DVM/SCW) Doctor giving update: Stephen Ward, DVM Update given: spoke with Mr Brant, Bingo resting well. Rad report didn't show any pnuumonia, Still possibilty of pancreatitis or other abdominal issue based on loss of serosal detail. May still need to evaluate further in not improving. Client Communications (1:56 am Stephen Ward, DVM/SCW) Doctor giving update: Stephen Ward, DVM Update given: spoke with owner, History and presenting complaint included tenesmus et.al. colitis signs as well. Will start on metronidazole as well. May still need to evaluate for other issues per radiologist report if not improving. Will reassess at 4 when I come in. Owner will come in around 5:00. Medications (2:15 am Stephen Ward, DVM/MEW) 250 mg Metronidazole inj (5mg/ml) IV slowly Laboratory (2:20 am Stephen Ward, DVM/MEW) PCV= 19%; TP= 6.2 g/dl;serum Transparency= clear; Serum Color= straw Diagnostics (2:23 am Stephen Ward, DVM/MEW) Chemistry Data (lcd) (February 21, :23 AM) Test Result Flag Normal Range Indicator Na (Mu10UL) II K (Mu10UL) I Na/K 25 I I I I CI (Mu10UL) II Patient Monitoring (4:12 am Stephen Ward, DVM/MEW) Time of TPR: 4:00 am Temp= dno F; HR= 160/min; Pulse Quality= strong; Resp= 25/min; MM= light pink; CRT= 1.5 seconds Pain Score = 2/10 Reasoning: Tense when touched, high heart rate DOD notified of possible pain. Buprenex to be given. Bingo showed no interest in water. Medications (4:13 am Stephen Ward, DVM/MEW) 0.12 mg Buprenex 0.5mg/mllV Patient Monitoring (6:35 am Stephen Ward, DVM/JRB) Time of TPR: 6:30 am Temp= F; HR= 130/min; Pulse Quality= good; Resp= 32/min; MM= light pink; CRT= 1.5 seconds Total volume of IV fluids administered at this time is 580 mls. Fluid rate is 60 mls per hour. Pain Score = 2/10 Reasoning: generalized malaise, weakness, uninterested and depressed attitude No interest in getting up at all. Skipped walk outside this hour. Medications (6:36 am Stephen Ward, DVM/JRB)

4 }OO mg, Ampicillin inj (+ )(30mg/ml) IV Patient Monitoring (7:29 am Stephen Ward, DVM/JRB) Bingo is not moving himself around. Rotated him to lay on his right side. Patient Monitoring (9:56 am Stephen Ward, DVM/AMB) Time of TPR: 10a Temp= F; HR= 120/min; Pulse Quality= adequate; Resp= 25/min; MM= light pink; CRT= 1.5 seconds Total volume of IV fluids administered at this time is 782 mls. Fluid rate is 60 mls per hour. Pain Score = Reasoning: NA Still lateral at this time Laboratory (10:17 am Stephen Ward, DVM/AMB) PCV= 18%; TP= 6.0 g/dl;serum Transparency= clear; Serum Color= colorless Diagnostics (10:17 am Stephen Ward, DVM/AMB) Chemistry Data (lvl) (February 21,201710:17 AM) Test Result Fla~1 Normal Range Indicator Sodium (Mv10UL) I Potassium :5.8 (Mv10 UL) Chloride (Mv10 UL) I II Patient Monitoring Owner visited. (11:24 am Stephen Ward, DVM/CT) Offered 20z chicken & rice, no interest. Offered water, no interest. Walked outside, he urinated. Patient Monitoring (12:13 pm Stephen Ward, DVM/CT) Weight: kg, b Scale used: treatment scale Medications (2:35 pm Stephen Ward, DVM/CT) 300 mg Ampicillin inj (+ )(30mg/ml) IV slowly 250 mg Metronidazole inj (5mg/ml) IV slowly Treatments (2:54 pm Stephen Ward, DVM/CT) Started on liter #2 of 0.9% NaCI. Fluids continued at 60 ml/hr. Client Communications (5:00 pm Stephen Ward, DVM/SCW) Doctor giving update: Stephen Ward, DVM Update given: spoke with Mr Brandt. Discussed ongoing care and status. Doing somewhat better. Did eat for owners this evening and more energetic. Temp has been in normal range. RIO still pyelonephritis and pancreatitis. Discussed potential for US with Dr Henrikson for neoplastic RIO but would coordinate with Dr Johnson first. Discussed QOL and EOL issues as well. Will keep Bingo overnight. If doing well may discharge in AM or early evening. Patient Monitoring (5:15 pm Stephen Ward, DVM/CT) Owners visited and took Bingo for a walk, he urinated a large amount. They also fed him baked chicken and he ate most of it. Patient Monitoring (5:16 pm Stephen Ward, DVM/CT) Time oftpr: 5:10 pm

5 Temp=,101.5 F; HR= 140/min; Pulse Quality= good; 'Resp= 24/min; MM= pink; CRT= 1 second Total volume of IV fluids administered at this time is 1164 mls. Fluid rate is 80 mls per hour. Pain Score = 0/10 Reasoning: no change Laboratory (6:17 pm Stephen Ward, DVM/CMS) PCV= 18%; TP= 5.6 g/dl;serum Transparency= clear; Serum Color= colorless Per Dr. Ward, we will decrease fluid rate to 70 mls! hour. Diagnostics (6:22 pm Stephen Ward, DVM/CMS) Chemistry Data (ICD) (F ebruary 21, :22 PM) Test Result Flag Normal Range Indicator Na (Mu10Ul) I K (Mu10Ul) I NafK 31 CI (Mu10Ul) I Patient Monitoring (10:46 pm Stephen Ward, DVM/KG) Time of TPR: 10pm Temp= F; HR= 150/min; Pulse Quality= good; Resp= 30/min; MM= pink; CRT= 1 second Total volume of IV fluids administered at this time is 1515 mls. Fluid rate is 60 mls per hour. Pain Score = 0/10 Reasoning: no change Bingo's IV fluid line was disconnected and his IV catheter is no longer patent. Walked outside - urinated a large amount. Offered fresh water - drank well. Iv fluids were decreased to 60 ml/hr. Procedures (10:47 pm Stephen Ward, DVM/KG) 20 gauge catheter placed into the left cephalic vein T-port was replaced. Medications (10:48 pm Stephen Ward, DVM/KG) 300 mg Ampicillin inj (+)(30mg/ml) IV 5.4 ml Baytrillnj 22.7mg/ml (+) diluted IV 7 mg Famotidine Inj (10mg/ml)(+) IV 13 mg Cerenia injection (10mg/ml) IV Veterinary Communications (11:11 pm Stephen Ward, DVM/SCW) Bingo was hospitalized overnight for 1 day(s). Client Communications (11:18 pm Stephen Ward, DVM/SeW) Doctor giving update: Stephen Ward, DVM Update given: Spoke with Mr Brandt. Bingo resting well, temp normal. No real change since spoke this afternoon. Tentative discharge in for AM, but that's at discretion of 000. May be better to treat until late afternoon. Will call with update at 4pm if still here. Patient Monitoring (11:47 pm Stephen Ward, DVM/KG) Offered 1/2 can i/d stew - no immediate interest. Left available. Prescribed Medications (11:58 pm Stephen Ward, DVM/SCW) Baytril Tabs (enrofloxacin) (68 mg) #7 Rx: Give 1 tablet(s) by mouth every 24 hours until gone

6 Clavamox tabs (250 mg) #14 Rx: Give 1 tablet(s) by mouth every 12 hours until gone Metronidazole tabs (250 mg ) #14 Rx: Give 1 tablet(s) by mouth every 12 hours until gone Wednesday, February 22, 2017 Patient Monitoring (12:56 am Stephen Ward, DVMNB) Owner came to visit today. When I went in to bring Bingo back to the treatment. He had coughed a few times. Had Dr. Christinat listen to Bingo prior to putting him back to bed. Owner took Bingo out for a walk this hour, he urinated while outside. Owner also tried to feed some kind of Beef to Bingo but he would not eat any of it. Medications (2:04 am Stephen Ward, DVM/MEW) 250 mg Metronidazole inj (5mg/ml) IV slowly on an infusion pump Laboratory (2:12 am Stephen Ward, DVM/MEW) PCV= 17%; TP= 4.4 g/dl;serum Transparency= clear; Serum Color= colorless Diagnostics (2:16 am Bryan Christinat, DVM/MEW) Chemistry Data (ICD) (February 22, : 16 AM) Test Result Flaq Normal Ranqe Indicator Na (MulOUL) I K (MulOUL) I Na/K 31 CI (MulOUL) I Patient Monitoring (3:50 am Stephen Ward, DVMNB) Time of TPR: 4 a.m. Temp= F; HR= 170/min; Pulse Quality= adequate; Resp= 30/min; MM= pink; CRT= 1 second Pain Score = 1/10 Medications (3:54 am Stephen Ward, DVM/MEW) 0.12mg Buprenex 0.5mg/ml IV Patient Monitoring (6:36 am Stephen Ward, DVM/JRB) Respiration Rate = 30/min Patient is not on oxygen at this time. Respiratory Score = 015 Bingo is sleeping Patient Monitoring (6:37 am Stephen Ward, DVM/JRB) Urinated large amount outside and had small, thin solid brown stool. Offered 2 oz chicken and rice, absolutely no interest. Previously offered food had not been disturbed. Water is available free choice. Medications (6:42 am Stephen Ward, DVM/JRB) 300 mg Ampicillin inj (+)(30mg/ml) IV Veterinary Communication (6:57 am Stephen Ward, DVM/MS) 2/22/2017, 06:57 AM Medical record faxed to Willowbend Animal Hospital at this time. Patient Monitoring (8:49 am Stephen Ward, DVM/JJE) Assessed Bingo this hour. Patient had clear fluid dripping from nose. Chest asculted- Clear yet mild harsh noises with RR of 28bpm. 000 notified. Lowered IVF to 45 ml/hr. DOD looked at transfer paperwork and noticed patient had been on Enalapril. Enalapril requested at this time.

7 Pain' Score- 1/10 Resting but acts lethargic Medications (8:50 am Stephen Ward, DVM/JJE) 7.5 mg Enalapril PO Patient Monitoring (10:27 am Stephen Ward, DVM/CT) Time of TPR: 10: 15 am Temp= F; HR= 132/min; Pulse Quality= good; Resp= 36/min; MM= pink; CRT= 1 second Total volume of IV fluids administered at this time is 2152 mls. Fluid rate is 45 mls per hour. Pain Score = Reasoning: no change Laboratory (11:03 am Stephen Ward, DVM/CT) PCV= 18%; TP= 5.4 g/dl;serum Transparency= clear; Serum Color= colorless Diagnostics (11:10 am Stephen Ward, DVM/CT) Chemistry Data (IVL) (February 22, :10AM) Test Result Flaq Normal Ranqe Indicator Sodium Potassium 151 Chloride 124 Patient Monitoring (12:32 pm Stephen Ward, DVM/JJE) Owner came in for a visit. To discharge later. Patient was offered food. No interest. Per Dr. Pratt Free choice water available (Mu10UL) (Mu10UL) I H (Mu10Ul) I I I II Owner took Bingo on a walk outside. Urinated at that time. Discontinued IVF and removed IV Catheter. Medications (2:15 pm Stephen Ward, DVM/JJE) 250 mg Clavamox PO 250 mg Metronidazole PO Patient Monitoring (4:00 pm Stephen Ward, DVMNB) Time of TPR: 4 p.m. Temp= did not obtain F; HR= 112/min; Pulse Quality= good; Resp= 32/min; MM= pink; CRT= 1 second Pain Score = 0/10 Reasoning: n/a Offered 1/8 can of lid, no interest in it Patient Monitoring (5:03 pm Stephen Ward, DVMNB), Bingo did not go out for a walk this hour as he is sleeping. Veterinary Communications (5:44 pm Stephen Ward, DVMNB) Subj: Medical Record for Bingo To: staff@willowbendanimalhospital.com Atch: EM pdf {double-click to view} Body:

8 Please see attached record.._".. ~ Veterinary Communications (5:46 pm Stephen Ward, DVMNB) Subj: Medical Record for Bingo To: staff@willowbendanimalhospital.com Atch: EM pdf {double-click to view} Body: Please see attached record. Veterinary Communications (6:17 pm Stephen Ward, DVM/SCW) owner requested appetitie stimulant Prescribed Medications (6:18 pm Stephen Ward, DVM/SCW) Mirtazapine Tabs 15mg #10 Rx: Give 1/2-1 tablet(s) by mouth every 24 hours until gone Discharge Instructions (6:25 pm Stephen Ward, DVM/SJP) DISCHARGE INSTRUCTIONS for Bingo Brandt VESHW Chart Number February 22, 2017 Bingo was treated here and is being sent home with the following instructions for you to do at home. Please follow these instructions carefully because Bingo's comfort and perhaps even his health depends on them. We have prescribed medications for "Bingo". Please read the label(s) carefully and call if you do not understand the instructions or if you have any questions. Discard any unused medication and do not keep it around for use on another pet. Federal law prohibits the use of a prescribed medication in an animal other than which it was prescribed. 1C\,-j;,4-r-- The next dose of Clavamox is due at 2 AM. ~ The next dose of Baytril is due at 10 PM.~-1i ~IO t& >, The next dose of Metronidazole is due when ou et home. t> ~ L I L The next dose of Mirtazapine is due when you get home. ~A.~ffe r--tt..r...-. We are recommending a bland diet for "Bingo". Add 1 cup BOILED hamburger or ground lamb (pour off the liquid) or 1 cup diced BOILED, SKINLESS chicken breast to 1 cup cooked white rice. Add 1/4-1/2 cup low fat cottage cheese. Feed "Bingo" 4-6 SMALL meals daily at first. After 2 days of this bland diet, begin mixing his regular diet with the bland diet (1/2 and 1/2). Feed mixture for next 2-3 days. Afterwards, feed regular diet. Please recheck with your regular veterinarian tomorrow or here again tonight if any other problems develop. Watch for any signs of a worsening condition such as pain/discomfort, weakness, depression, straining to urinate or defecate, vomiting, diarrhea, or anorexia. If any unusual symptoms occur with Bingo, please call your referring veterinarian or Veterinary Emergency and Specialty Hospital of Wichita as soon as possible. Thank you for choosing Veterinary Emergency and Specialty Hospital of Wichita for Bingo's veterinary needs. We realize that an emergency with your pet is never a pleasant experience, but we do hope that you were happy with our service. We look forward to being here to serve you if you ever need us again in the future. Please feel free to call us if you have any questions or concerns about Bingo. Sincerely, Stephen Ward, DVM