Color: Black & White. Date Type Staff History

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1 12/19/2017 L AO Chemistry results from IDEXX VetLab In-clinic Laboratory Requisition ID: 9108 Posted Final Test Result Reference Range ALB = 2.6 g/dl ALKP = 16 U/L ALT = 114 U/L AMYL = 770 U/L BUN/UREA = 25 mg/dl Ca = 8.2 mg/dl Chloride = 117 mmol/l CHOL = 275 mg/dl H CREA = 1.8 mg/dl GGT = 0 U/L 0-4 GLU = 156 mg/dl LIPA = 758 U/L PHOS = 4.3 mg/dl Potassium = 3.8 mmol/l TBIL = 0.3 mg/dl TP = 8.1 g/dl Sodium = 158 mmol/l GLOB = 5.5 g/dl H OSM calc = 319 mmol/kg ALB/GLOB = 0.5 BUN/CREA = 14 Na/K = 42 12/19/2017 L AO Hematology results from IDEXX VetLab In-clinic Laboratory Requisition ID: 9108 Posted Final Test Result Reference Range BASO = 0.10 K/uL EOS = 0.08 K/uL L HCT = 36.7 % HGB = 11.3 g/dl LYMPHS * * 4.74 K/uL MCH = 14.1 pg MCHC = 30.8 g/dl MCV = 45.9 fl MONOS * * 0.38 K/uL MPV = 17.9 fl RBC = 8.00 M/uL WBC = K/uL %LYMPHS * * 30.3 % %MONOS * * 2.4 % NEUT * * K/uL H %NEUT * * 66.2 % %EOS = 0.5 % %BASO = 0.6 % PLT = 197 K/uL Parkway Veterinary Hospital Page 1 of 23 Date: 12/21/2017 8:52 AM

2 Retics = 8.0 K/uL %Retics = 0.1 % RDW = 21.6 % PCT = 0.35 % Band * * Suspected Band neutrophils suspected WBC Abnormal Distribution 12/19/2017 P AO 2.00 tablet of Mirtazapine 15mg (I8909) Rx #: Of 0 Refills Filled by: VT Give 1/4 tablet by mouth every hours. 12/19/2017 C AO Continued ADR - FINAL 12/19/2017 Patient: " Kitty" Alexe Age: 12 Yrs. 7 Mos. Date: 12/19/2017 Species: Feline Breed: Domestic Shorthair Here for concerns of continued anorexia and lethargy. o says that Kitty is hiding and spending time in the closet which is very abnormal. Kitty received Cerenia injection yesterday and o gave Cerenia this morning and Kitty has not vomited at all. She ate a small amount of food this morning after o added some water to it but normally has a pretty good appetite. No pu/pd. Urinating normally. No BM since Sunday. T: P: 180 R: 32 Oral: moderate dental calculus CV: NSR, grade II/VI parasternal murmur, slightly dehydrated, pulses s/s Abd: tense, non-painful, no appreciable organomegaly/masses, subjectively distended MS: ambulatory x4 Exam, CBC = neutrophilia, Profile = Globulin 5.5, Chol 275, 100mL SQ fluids o declined: abdominal radiographs, drop off for IV fluids Client education: PE findings, ddx for continued ADR - metabolic disease, neoplasia etc., discussed heart murmur - o says it has been heard intermittently in the past, discussed fever of unknown origin - recommend BW and radiographs, discussed overall normal BW, recommend hospitalization with IV fluids for remainder of today - o declines because she thinks it will be too stressful for Kitty, o will consider dropping off for IV fluids tomorrow if Kitty is still ADR, benefits of AXR - o declines d/t stress, o requests appetite stimulant - RX Mirtazapine, let o know we still have not found underlying cause of ADR so need to consider more dx if no improvement Parkway Veterinary Hospital Page 2 of 23 Date: 12/21/2017 8:52 AM

3 **After appointment o says she lined bottom of Kitty's carrier with hot water bottles and wanted to know if this could have contributed to her elevated temperature - YES. Recommend rechecking rectal temperature in a few hours** Amanda O'Shea, DVM 12/19/2017 V AO Dec 19, :52 PM Staff: AO Weight : 9.80 pounds 12/19/2017 V AO Dec 19, :46 PM Staff: AO Weight : 9.80 pounds 12/18/2017 TC JAB JAB Preventative Basic - TENTATIVE - vomited 2x yesterday, inappetent today Examination: Subjective: nails trimmed vomited food first yesterday in the afternoon around 1 pm, then vomited clear, didn't eat last night or this morning maybe hiding more drank water yesterday and today good litterbox habits energy level okay on purina natural and some i/d dry typically. O did introduce some halo dry over the course of the last month. Temp: Pulse: Respiration: Objective: Normal Abnormal Did Not Examine Comments Parkway Veterinary Hospital Page 3 of 23 Date: 12/21/2017 8:52 AM

4 Abdomen Cardiovascular Ears Eyes Gastrointestinal Mouth / Teeth Membranes/Nodes Musculoskeletal Nervous System Respiratory Skin / Hair soft, nonpainful no murmur or arrhythmia noted clean visual, no discharge vomiting, gland expressed (left) per o request - full, expressed easily pink mm CRT <2 sec, tartar WNL amb x 4 BAR lungs clear no fleas or flea dirt noted Urogenital not done/feline Positive Negative Heartworm Lyme Ehrlichia Anaplasma Assessment: vomiting/inappetent Plan: cerenia 0.6 cc sq rx. cerenia 16 mg: start tomorrow. 1 sid disp hill's i/d 6 cans rec bloodwork +/- abdominal radiographs (abd. ultrasound) if does not improve. O understands Parkway Veterinary Hospital Page 4 of 23 Date: 12/21/2017 8:52 AM

5 12/18/2017 V JAB Dec 18, :03 PM Staff: JAB Weight : pounds 12/18/2017 P JAB 1.00 box of Cerenia 16mg Tablets Box of 4 (I8179) Rx #: Of 0 Refills Filled by: JAB Give 1 tablet orally once daily. Start tomorrow. 9/9/2017 C JAB JAB Preventative Basic - CLOSED 09/16/ anal gland expression requested Examination: Subjective: no scooting noted, normal stool eating and drinking well vomited 2x in the last month, prior months no vomiting noted nails trimmed (in room with o) had assistant present requested gland expression, only has left gland, only does expressions with DVM does shake/tremor occasionally over last few months, o reports lasts only a moment and pet is cognitive Temp: Pulse: Respiration: Objective: Normal Abnormal Did Not Examine Abdomen Cardiovascular Ears Eyes Comments soft, nonpainful no murmur or arrhythmia noted clean visual, no discharge Parkway Veterinary Hospital Page 5 of 23 Date: 12/21/2017 8:52 AM

6 Gastrointestinal Mouth / Teeth Membranes/Nodes Musculoskeletal Nervous System Respiratory Skin / Hair no vomiting or diarrhea, expressed moderately full gland, as kitty rolled over pink mm CRT <2 sec, tartar WNL amb x 4 BAR lungs clear no fleas or flea dirt noted Urogenital not done/due Positive Negative Heartworm Lyme Ehrlichia Anaplasma Assessment: healthy p Plan: discussed occasional vomiting, not a terrible high frequency. Discussed option for bland/easy to digest diet, hill's i/d. O would like to mix with current food. okay to try. i/d 4# 6 cans i/d nails trimmed anal glands expressed. o will monitor shaking Parkway Veterinary Hospital Page 6 of 23 Date: 12/21/2017 8:52 AM

7 9/9/2017 V JAB Sep 9, :06 AM Staff: JAB Weight : 9.60 pounds 4/22/2017 C JAB JAB Preventative Basic - CLOSED 04/29/ AWE, purevax rabies 1 year, nails trimmed Examination: Subjective: o reports licking rear a little, requests gland be expressed no concerns eating and drinking well indoor o interested in fish oil supplement - rec pick up from pet store Temp: Pulse: Respiration: Objective: Normal Abnormal Did Not Examine Abdomen Cardiovascular Ears Eyes Gastrointestinal Mouth / Teeth Membranes/Nodes Musculoskeletal Nervous System Comments soft, nonpainful no murmur or arrhythmia noted clean visual, no discharge no vomiting or diarrhea, expressed full left gland pink mm CRT <2 sec WNL good ROM to hips and stifles, amb x 4 BAR Parkway Veterinary Hospital Page 7 of 23 Date: 12/21/2017 8:52 AM

8 Respiratory Skin / Hair lungs clear no fleas or flea dirt noted Urogenital not done/due Positive Negative Heartworm Lyme Ehrlichia Anaplasma Assessment: healthy p Plan: purevax rabies right rear sq 1 year nails trimmed anal gland expressed. 4/22/2017 R JAB Rabies Certificate - NASPHV - CLOSED 04/24/2017 RABIES VACCINATION CERTIFICATE Owner's Name & Address Gabriela Alexe Address: 106 Sherman Rd Animal Name: Kitty RABIES TAG # MICROCHIP # TELEPHONE # (732) City, State Zip: Weight: 9.9 Predominant Breed: Domestic Shorthair Parkway Veterinary Hospital Page 8 of 23 Date: 12/21/2017 8:52 AM

9 Species: Feline DATE VACCINATED: 4/22/2017 NEXT VACCINATION DUE BY: 4/22/2018 Age: 11 Yrs. 11 Mos. Sex: Spayed Female Product Name: Purevax Rabies 1yr-Inventory Manufacturer: Merial USDA LICENSED VACC 1 Markings: Veterinarian's Name: Jenna A. Breslin License Number: Vaccine Serial (Lot) No. Veterinarian's Signature Address: Parkway Veterinary Hospital 18 Spring Street West Roxbury, MA Phone: (617) /22/2017 V JAB Apr 22, :09 PM Staff: JAB Weight : 9.90 pounds 12/8/2016 C JAB lmom for Kitty's rad report - CLOSED 12/15/2016 GI tract unremarkable, slightly reduced kidney size with normal shape. Could be normal variation for pet or could be significant of kidney disease, next steps are bloodwork (renal panel) and consideration for abdominal ultrasound. rec o return call to discuss. Parkway Veterinary Hospital Page 9 of 23 Date: 12/21/2017 8:52 AM

10 12/5/2016 TR Telemedicine Result: /3/2016 P JAB 1.00 tube of Animax Ointment 15mL (I822) Rx #: Of 0 Refills Filled by: JAB Apply a small amount to rear twice daily as needed. 12/3/2016 V JAB Dec 3, :42 PM Staff: JAB Weight : pounds 12/3/2016 C JAB JAB Preventative Basic - CLOSED 12/10/ bleeding from bottom ***ADDENDUM 4/22/2017 Examination: Subjective: O reports saw pet urinate before arriving, has observed pet straining to defecate last few days. Went to litterbox several times on Thursday. O concerned constipated at this time eating and drinking well urinating fine o put an ointment on the rear end since it looked bloody and inflamed Temp: Pulse: Respiration: Objective: Normal Abnormal Did Not Examine Abdomen Cardiovascular Ears Eyes Gastrointestinal Mouth / Teeth Membranes/Nodes Comments soft, nonpainful grade 3 murmur ausculted clean visual, no discharge no vomiting or diarrhea, rectal - unremarkable no formed stool in colon, expressed left gland that was full pink mm CRT <2 sec WNL Parkway Veterinary Hospital Page 10 of 23 Date: 12/21/2017 8:52 AM

11 Musculoskeletal Nervous System Respiratory Skin / Hair amb x 4 BAR lungs clear no fleas or flea dirt noted Urogenital not done/due Positive Negative Heartworm Lyme Ehrlichia Anaplasma Assessment: full gland versus constipation Plan: discussed with o - do not feel any formed stool in colon at this time to be concerned with constipation, offered abdominal film to better evaluate intestinal tract though. O elected. O wanted to accompany pet to have radiographs done. advised client legally she can not be present for radiographs. expressed small amount of normal gland material from left gland. Pet does not have the right gland present any longer. rx. animax apply a small amount to rear twice daily as needed. use a glove. Rec o call INI or worsens fecal pending nails trimmed. ADDENDUM on 4/22/2017 at 13:20:11 from Jenna A. Breslin ON PE, no murmur ausculted, entered in error jab Parkway Veterinary Hospital Page 11 of 23 Date: 12/21/2017 8:52 AM

12 12/3/2016 T ADM Image: Abdomen 12/3/2016 L JAB Microbiology results from IDEXX Reference Laboratory Requisition ID: Posted Final Test Result Reference Range OVA&PARA Ascn: OVA & PARASITES NO OVA OR PARASITES SEEN In cases of acute or chronic diarrhea in addition to a fecal floatation 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: test code 2627). 9/16/2016 C JAB lmom on 9/13/16 - nsf on bloodwork, rec o call with update - CLOSED 09/23/2016 9/12/2016 L JAB Chemistry results from IDEXX Reference Laboratory Requisition ID: Posted Final Test Result Reference Range ALB 3.0 g/dl ALKP 15 U/L ALT 70 U/L AMYL 1556 U/L ANION GAP 22 mmol/l AST 33 U/L BICARB 15 mmol/l BUN/UREA 31 mg/dl Ca 9.7 mg/dl Chloride 120 mmol/l CHOL 226 mg/dl CREA 1.4 mg/dl DBIL 0.0 mg/dl GGT 6 U/L 0-6 Parkway Veterinary Hospital Page 12 of 23 Date: 12/21/2017 8:52 AM

13 GLU 99 mg/dl IBIL 0.0 mg/dl LIPA 156 U/L PHOS 5.1 mg/dl Potassium 4.6 mmol/l TBIL 0.0 mg/dl TP 6.7 g/dl Sodium 152 mmol/l A/G Ratio B/C Ratio 22.1 Na/K Ratio GLOB 3.7 g/dl CK 248 U/L SDMA 9 ug/dl 0-14 Ascn: R SS,46 CROSSED OFF BY CLIENT ON REQ.,/FELINE RE: 281 HEMOLYSIS INDEX ++ Index of N,+,++ exhibits no significant effect on chemistry values. RE: 282 LIPEMIA INDEX N Index of N,+,++ exhibits no significant effect on chemistry values. BOTH SDMA AND CREATININE ARE WITHIN THE REFERENCE INTERVAL which indicates kidney function is likely good. If SDMA and/or creatinine is at the upper end of the reference interval, early kidney disease cannot be ruled out. Evaluate a complete urinalysis to confirm there is no other evidence of kidney disease. 9/12/2016 L JAB Endocrinology results from IDEXX Reference Laboratory Requisition ID: Posted Final Test Result Reference Range T4 1.6 ug/dl Ascn: R SS,46 CROSSED OFF BY CLIENT ON REQ.,/FELINE Interpretive ranges: <0.8 Subnormal Normal Grey zone in old or symptomatic cats >4.7 Consistent with hyperthyroidism Cats with subnormal T4 values are almost exclusively euthyroid sick or Parkway Veterinary Hospital Page 13 of 23 Date: 12/21/2017 8:52 AM

14 overtreated for their hyperthyroidism. Older cats with consistent clinical signs and T4 values in the grey zone may have early hyperthyroidism or a concurrent non-thyroidal illness. Hyperthyroidism may be confirmed in these cats by adding on a free T4 or by performing a T3 suppression test. Following treatment with methimazole, T4 values will generally fall within the lower end of the reference range ( ). 9/12/2016 C JAB JAB Preventative Basic - CLOSED 09/19/ vomited saturday Examination: Subjective: 11# 3 oz several times during the day on saturday vomiting noted, some fur ate food sunday with some water added to canned food good energy nails trimmed expressed left gland - full, expressed easily per o request Temp: Pulse: Respiration: Objective: Normal Abnormal Did Not Examine Abdomen Cardiovascular Ears Eyes Comments soft, nonpainful no murmur or arrhythmia noted clean visual, no discharge Parkway Veterinary Hospital Page 14 of 23 Date: 12/21/2017 8:52 AM

15 Gastrointestinal Mouth / Teeth Membranes/Nodes Musculoskeletal Nervous System Respiratory Skin / Hair vomiting, no BM seen recently, on rectal nsf pink mm CRT <2 sec WNL amb x 4 BAR lungs clear no fleas or flea dirt noted Urogenital not done/feline Positive Negative Heartworm Lyme Erlichia Anaplasma Assessment: vomiting, r/o gi, renal, thyroid other Plan: cerenia 0.5 cc sq declined sq fluids chem +t4 - o became concerned with blood draw in room, unable to obtain more for cbc, if cbc needed will have o bring pet in again. 9/12/2016 V BA Sep 12, :44 AM Staff: BA Weight : pounds Parkway Veterinary Hospital Page 15 of 23 Date: 12/21/2017 8:52 AM

16 11/25/2015 C SH SH- Feline Annual - CLOSED 12/02/ annual Examination: Subjective: Any C/S/V/D/PU/PD?no doing fine licking left anal gland Food: Canned Dry Indoor Only Out&In Number of other cats in household: Temp: Pulse: Respiration: Wt: /25/2015 Objective: Normal Abnormal Did Not Examine Abdomen Comments Cardiovascular Ears Eyes Gastrointestinal Mouth / Teeth Membranes/Nodes Musculoskeletal Nervous System Respiratory Skin / Hair Urogenital exp small dschg left anal gland Parkway Veterinary Hospital Page 16 of 23 Date: 12/21/2017 8:52 AM

17 TESTING Positive Negative Sent Out Not Performed Fecal FeLV FIV HW Vaccines Rabies RH SQ 1yr 3yr FVRCP RF SQ #1 #2 1yr 3yr FeLV #1 1yr Assessment: nt Plan: Feline Revolution Frontline Advantage /25/2015 R SH Rabies Certificate - NASPHV - CLOSED 11/27/2015 RABIES VACCINATION CERTIFICATE Owner's Name & Address Gabriela Alexe Address: 106 Sherman Rd RABIES TAG # MICROCHIP # TELEPHONE # (732) City, State Chestnut Hill, MA Zip: Parkway Veterinary Hospital Page 17 of 23 Date: 12/21/2017 8:52 AM

18 Animal Name: Kitty Species: Feline DATE VACCINATED: 11/25/2015 NEXT VACCINATION DUE BY: 11/25/2016 Age: 10 Yrs. 6 Mos. Sex: Spayed Female Product Name: Purevax Rabies 1yr-Inventory Manufacturer: Merial USDA LICENSED VACC 1 Weight: 11.6 Markings: Veterinarian's Name: Sandy Higgins, DVM License Number: 4002 Predominant Breed: Domestic Shorthair 17390B Vaccine Serial (Lot) No. Veterinarian's Signature Address: Parkway Veterinary Hospital 18 Spring Street West Roxbury, MA Phone: (617) /25/2015 V SH Nov 25, :19 AM Staff: SH Weight : pounds 5/4/2015 C SH anal left exp - CLOSED 05/11/2015 exp small amount dschg from left gland - not sure necessary to do unless cat is uncomfortable and explained to o Parkway Veterinary Hospital Page 18 of 23 Date: 12/21/2017 8:52 AM

19 12/24/2014 C SH A/G [x] R full. expressed. Material very thick. L has been removed. N/T [x] AL/AMB - CLOSED 12/31/2014 A/G [x] R full. expressed. Material very thick. L has been removed. N/T [x] AL/AMB 6/30/2014 V EB Jun 30, :35 AM Staff: EB Weight : pounds 6/30/2014 R SH Rabies Certificate - NASPHV - CLOSED 07/01/2014 RABIES VACCINATION CERTIFICATE Owner's Name & Address Gabriela Alexe Address: 106 Sherman Rd Animal Name: Kitty Species: Feline DATE VACCINATED: 6/30/2014 NEXT VACCINATION DUE BY: 6/30/2015 Age: 9 Yrs. 1 Mos. Sex: Spayed Female Product Name: Purevax Rabies-Inventory Manufacturer: Merial USDA LICENSED VACC 1 RABIES TAG # 2584 MICROCHIP # TELEPHONE # (732) City, State Zip: Weight: 11.4 Markings: Veterinarian's Name: Sandy Higgins, DVM License Number: 4002 Predominant Breed: Domestic Shorthair 17357b Vaccine Serial (Lot) No. Parkway Veterinary Hospital Page 19 of 23 Date: 12/21/2017 8:52 AM

20 Veterinarian's Signature Address: Parkway Veterinary Hospital 18 Spring Street West Roxbury, MA Phone: (617) /30/2014 C SH SH- Feline Annual - CLOSED 07/07/2014 Examination: Subjective: Any C/S/V/D/PU/PD? Food: Canned Dry had pe last year in CT Indoor Only Out&In Number of other cats in household: 0 Temp: Pulse: Respiration: Wt: /11/2012 Objective: Normal Abnormal Did Not Examine Abdomen Cardiovascular Ears Comments grade 3/6 systolic murmur with incr HR that resolves with slow rate! Eyes Parkway Veterinary Hospital Page 20 of 23 Date: 12/21/2017 8:52 AM

21 Gastrointestinal Mouth / Teeth Membranes/Nodes Musculoskeletal Nervous System Respiratory Skin / Hair Urogenital TESTING Positive Negative Sent Out Not Performed Fecal FeLV FIV HW Vaccines Rabies RH sq 1yr 3yr FVRCP RF SQ 1yr 3yr FeLV #1 1yr Assessment: anals exp only one side - other side removed exp small plug dischg left Plan: Parkway Veterinary Hospital Page 21 of 23 Date: 12/21/2017 8:52 AM

22 9/6/2013 C VT Visit: Patient check-in Entered By: LW 9/6/2013 C VT Medical Condition Subjective: nail trim anal glands, will sched annual rabies upon leaving Entered By: LW 9/6/2013 C VT Notes: nail trim anal glands, will sched annual rabies upon leaving 4/15/2013 C VT Visit: Patient check-in Entered By: LW 4/15/2013 C VT Medical Condition Subjective: o req VT for nails & anal gland expression Entered By: LW 4/15/2013 C VT Notes: o req VT for nails & anal gland expression 12/24/2012 C VT Visit: Patient check-in Entered By: NL 12/24/2012 C VT Medical Condition Subjective: Nail trim Parkway Veterinary Hospital Page 22 of 23 Date: 12/21/2017 8:52 AM

23 Entered By: NL 12/24/2012 C VT Notes: Nail trim 9/25/2012 C SH Visit: Patient check-in Entered By: LW Meet and Greet 9/25/2012 C SH Notes: Meet and Greet 9/25/2012 C SH Medical Condition Subjective: Meet and Greet Entered By: LW 8/11/2012 V Aug 11, :00 AM Weight : pounds Parkway Veterinary Hospital Page 23 of 23 Date: 12/21/2017 8:52 AM