Liver US

Due to the increasing liver values, I recommend an abdominal ultrasound - this would allow us to look at the internal architecture of the liver, in addition to the intestines, pancreas, stomach, kidneys, bladder, abdominal lymph nodes and adrenal glands. The liver could be inflammed, infected, have a tumor, or could have a benign aging change called vacuolar hepatopathy. It may not give us all the answers, but it is the test that will likely give us the most information, without needing anesthesia. We have a traveling ultrasonographer who can come to the clinic to do it (cost is ~$4-500) or you can set it up at one of the local specialty clinics like Premier, VSC Buffalo Grove, or VCA Aurora.

If you elect to set this up. we will want to give XXXXX a dose of both Gabapentin and Trazodone  3 hours before the appointment as it will help him/her relax before the procedure. He/she would need to be fasted 12 hours before the ultrasound.

Differential diagnoses:  Otitis 

Diagnostics/Radiographs: 

Ear cytology

Right:

Left:

Prognosis: Good
In-Hospital Treatments: Flushed the ears

Owner Instructions:  Please start XXXXX on the following treatment plan:

• Flush the ear(s) with EpiOtic every 3 days for the next 2 weeks. 
• Instill a 1 inch strip (or about 6 drops) of Mometamax into the affected ear canal and massage at the base once a day for the next week.
• Claro was instilled in the affected ear(s). This treatment will last for 30 days. Do not flush, clean or swab the ear for 30 days while it works. Avoid water as well. 
• If the ear(s) are not back to normal in 2 weeks, or if they worsen before that, please schedule a recheck.

Follow-up: We’ll email for a follow-up in 2 days.

Differential diagnoses:  Torn nail 

Prognosis: Good

In-Hospital Treatments:  

Owner Instructions:  Please start XXXXX on the following treatment plan:

• Please remove the bandage in 6-8 hours. If there is any further bleeding, pack it with some corn starch and apply pressure for 10 minutes. If there is still a lot of bleeding, come back in or go to the ER if after hours.
• Use a bootie while outside for the next 3-4 days to keep the foot clean and dry.
• Use an E-Collar for the next 3-4 days, to ensure the toe is not licked excessively.
• Start the anti-inflammatory Rimadyl at XXXXX for the next 4 days.
• Recheck if the toe is still painful, there is discharge or it becomes swollen.

Follow-up: We’ll email for a follow-up in 2 day

Differential diagnoses:  Torn nail 

Prognosis: Good

In-Hospital Treatments:  

Owner Instructions:  Please start XXXXX on the following treatment plan:

• Please remove the bandage in 6-8 hours. If there is any further bleeding, pack it with some corn starch and apply pressure for 10 minutes. If there is still a lot of bleeding, come back in or go to the ER if after hours.
• Use a bootie while outside for the next 3-4 days to keep the foot clean and dry.
• Use an E-Collar for the next 3-4 days, to ensure the toe is not licked excessively.
• Start the anti-inflammatory Rimadyl at XXXXX for the next 4 days.
• Recheck if the toe is still painful, there is discharge or it becomes swollen.

Follow-up: We’ll email for a follow-up in 2 day

Differential diagnoses: Suspect Kennel Cough (Infectious Tracheobronchitis) vs pneumonia, collapsing trachea, other

Prognosis: Good

Owner Instructions:  Please start XXXXX on the following treatment plan:

• Start the antibiotic Doxycycline 100mg at XXXXX twice a day for 10 days.
• Use the cough suppressant Cough Tabs at XXXXX every 8-12 hours as needed for the next week. 
• Avoid other dogs for 2 weeks from the onset of coughing.
• If the cough worsens, thick nasal discharge develops, or lethargy/inappetance develop, please let us know – we may want to recheck and take radiographs to look for pneumonia.

Follow-up: We’ll email for a follow-up in 2 days.

Differential diagnoses:  R/O Soft tissue injury vs fracture, arthritis, neurologic

Diagnostics/Radiographs: 

Prognosis: Good

In-Hospital Treatments: 

Owner Instructions:  Please start XXXXX on the following treatment plan:

• Start the anti-inflammatory Rimadyl at XXXXX twice a day
• Start Gabapentin for pain at XXXXXXXX every 8-12 hours. This may cause mild sedation.
• Strict rest for the next week. This means short leash walks only – no dog park, daycare, or roughhousing.
• If there is no improvement in 3-4 days or if the limp worsens, please set up a recheck so we can reassess the limb and possibly take x-rays.

Follow-up: We’ll email for a follow-up in 2 days.

Differential Diagnosis: Conjunctivitis OU - R/O irritant, bacterial, viral, allergic

Diagnostics/Radiographs:  Fluorescein test negative OU 

Owner Instructions: Please apply 1 drop of NeoPolyDex eye drops every 12 hours for the next 7 days. If XXXXX starts to scratch, I recommend using an E-Collar. If it worsens, or if there is no improvement in 3-4 days, or if it goes away and then relapses, please let us know.

Follow up: We'll call or email for a follow-up in 2 days

Differential diagnoses: Ingestion of 

Diagnostics/Radiographs:  

Prognosis: Good

In-Hospital Treatments: Fed W/D. Gave Apomorphine IV -Vomited XXXX

Cerenia 

Owner Instructions:

• XXXX may also be a little groggy the rest of the day.
• OK to feed a small meal in 3-4 hours. Water is OK.

Follow up: We'll call for a follow-up tomorrow.

Differential diagnoses: Likely allergic reaction

Prognosis: Good

In-Hospital Treatments: cc Dexamethasone IM,  cc Diphenhydramine IM  

Owner Instructions: 

-Please give XXXXX a bath when you get home, in case there is any residual allergen on the skin. 

-In 6 hours, start over-the-counter plain Benadryl at XXXXXmg three times a day. This may cause drowsiness. Continue plain Benadryl for 48 hours.

-If there is any trouble breathing, vomiting, or if the skin worsens, get in touch with a vet right away.

Follow up: We'll check in tomorrow.

Differential diagnoses: Bite wounds

Prognosis: Good

In-Hospital Treatments: Clipped and cleaned, flushed well with dilute chlorhexidine.

Owner Instructions: Please start XXXXX on the following treatments:

• Give Clavamox at XXXmg twice a day for 7 days. Give with food.
• Give Rimadyl at XXmg twice a day for 5 days. Give with food.
• Warm compress the wounds twice a day followed by gently cleaning with dilute chlorhexidine (1 part chlorhexidine to 3 parts warm water) for a week.
• Please use an E-Collar to protect the wounds if trying to lick/scratch at them.
• If you note thick discharge coming from the wounds, or if they become very red or swollen, please set up a recheck so we can check to see if the wounds have become infected.
• Keep XXXXX quiet for the next week while the wounds heal.

Follow up: We'll check back in 2 days to see how the wounds are progressing.

Differential diagnoses:  Superficial moist dermatitis, aka "Hot Spot"
Prognosis: Good
Plan: Medical management
In-Hospital Treatments: Clipped and cleaned with dilute chlorhexidine, applied Quad Ointment
Owner Instructions: 

-For the next week, twice a day, clean the area with chlorhexidine diluted with 3 parts warm water. 

-Follow this with a thin layer of Quad Ointment

-Give XXXXXXX for 10 days- this is an antibiotic- give with food.
Follow up: We'll email in 2 days for a follow-up. Let us know sooner if worsening.

Differential diagnoses: Anal gland abscess  

Prognosis: Good

Plan: Medical management

In-Hospital Treatments: Clipped, cleaned and flushed with chlorhexidine  

Owner Instructions: Please start XXXX on the following treatments:

• Warm compress the draining tract twice a day for 5 mintues.
• Follow the compress by gently cleaning with chlorhexidine, diluted with 3 parts warm water.
• Give Clavamox at XXXmg twice a day for 7 days.
• Give Rimadyl at XXXmg tablet twice a day for 7 days.
• Use an E-Collar to prevent licking.

Follow up: We'll email in 2 days to see how it’s healing - call us sooner if it appears to be worsening.

Itching or licking of the skin, feet or ears can be a sign of allergies. Food allergies and environmental allergies are the two main categories of allergies.

Either can manifest as ear infections, foot licking, and/or itchiness. 

1) With food allergies, pets are most commonly allergic to proteins (chicken, beef, dairy, etc). A very small percentage of pets are actually allergic to grains. Additionally, grain-free diets may be linked to heart disease and are therefore not typically recommended. 

To evaluate for food allergy, I recommend that a “food trial” be performed.  In a food trial, you would feed a protein which your pet has never been exposed to before (kangaroo, buffalo, venison, etc.) or a protein that has been hydrolyzed, for 2 months exclusively (meaning no protein based treats or flavored medications). You can substitute carrots and green beans for treats. I strongly recommend starting with a prescription hypoallergenic diet as these are much more pure than over-the-counter versions, and therefore, more likely to work. 

2) Environmental allergies can be either seasonal (ex: pollen, grass) or non seasonal (ex: dust mites). 

The best medications for allergic itch control are Apoquel (a daily pill) and Cytopoint (an injection like a vaccine lasting 4-6 weeks). These medications are not anti-histamines or steroids, and do not have any significant side effects when given at the appropriate dosage in the short term. They work by blocking a complicated molecular pathway that leads to the feeling of itchiness. Some animals only need to be on them during the warmer months (spring through fall) while environmental allergies are most prevalent, while others do better with year round use. I prefer to use Cytopoint when possible, as Apoquel potentially can have immune side effects when used in the long term (though not common) - as a result, Apoquel requires testing bloodwork 1 month after starting it and then every 6 months thereafter. If successful, Cytopoint injections can be arranged as a technician appointment in the future.

Additionally, I would do the following:  

1) Wipe legs and paws with a damp washcloth, paper towel, or baby wipe after every trip outside.  You should also wipe down other areas that have contact with the ground such as the abdomen if they have been lying in grass.  

2) Start an Omega-3 fatty acid (Fish Oil) that provides  ______ mg of EPA per day.  As a poorly regulated supplement, it is difficult to have confidence in all brands labeled concentration but Nordic Naturals is a relatively trusted brand.  Prescription versions are available through our practice that we have more confidence in

3) Bathe at least once a week with a medicated shampoo. Medicated baths are more powerful than over-the-counter baths are are more likely to work.  Leave the lather on for 10 minutes before rinsing. 

4) You can give ___ mg of plain Benadryl, (Diphenhydramine) or ___mg of plain Zyrtec (not Zyrtec-D) both over-the-counter antihistamines, every 8-12 hours as needed to reduce itching. This may not be effective in all pets. Try each one separately for 2 weeks to see if they help.

Differential diagnoses: Feline Lower Urinary Tract Disorder – R/O sterile cystitis, crystaluria, urinary tract infection, bladder stones
Diagnostics/Radiographs: Urinalysis:
Prognosis: Good
In-Hospital Treatments:
Feline lower urinary tract disease (FLUTD) also know by other acronyms such as FIC and FUS, is a common disorder in cats, especially males. It is believed to be caused by sterile inflammation, which can lead to crystal or mucoid material formation that can irritate the urinary tract. It's not known why this happens in some cats and not in others, though stress, diet and water intake are believed to play a role. Other less common reasons for cats to develop inflammation include bladder stones, urinary infection and bladder tumors.When FLUTD happens, common signs include:

• 1. Going in and out of the litterbox
• 2. Blood in the urine
• 3. Licking the penis
• 4. Vocalizing

The crystals and/or mucous can also sometimes cause plugs that can prevent a cat from urinating. When they cannot urinate, it is a life threatening emergency.
Signs of urinary obstruction can include:

• 1. Vomiting
• 2. Straining to urinate with no urine production
• 3. Acting painful and isolating himself

Owner Instructions: Please start XXXX on the following treatments:

• Please give Buprenex at XXXXX twice a day, either under the tongue or in the cheek pouch. This may cause mild sedation or constipation
• Give 1 tablet of Onsior once a day for 3 days.
• To reduce stress, one of the underlying issues leading to FLUTD in some cats, I recommended the Indoor Pet Initiative by The Ohio State University (indoorpet.osu.edu/cats) for ideas to reduce environmental stress in your home. 
• Increasing water consumption can also help some cats. Use multiple water bowls around the house and change the water daily to keep it fresh. Water fountains are also great for many cats as they often prefer moving water.

Follow up: We'll call tomorrow for a follow-up.

Please contact us or Veterinary Emergency Group on North Ave  (312) 757-5444 , MedVet Chicago on California (773) 281-7110, or Premier on Belmont  (773) 516-5800  if you should see any of the following as they may indicate an undesired reaction to the vaccines administered on today's visit:

-Lethargy, diarrhea or loss of appetite that lasts longer than 48 hours

-Facial swelling or sudden, excessive scratching of the muzzle and or eyes

-Vomiting multiple times in a short period with weakness, loss of balance or pale gums.

The local veterinary ERs are:  

-Veterinary Emergency Group at 755 W. North Ave  (312) 757-5444 - they are only open nights and weekends

 -MedVet Chicago at 3305 N. California (773) 281-7110, -they are open 24/7

-Premier at 3927 W. Belmont  (773) 516-5800 - they are open 24/7

Cardiologists in the Chicago area include:

-BluePearl Northfield 847.564.5775

-Premier Grayslake 847.548.5300

-VCA Aurora 630.301.6100

-VSC Buffalo Grove 847.459.7535 

We've recently started recommending a mild oral sedative for pets prior to echocardiograms and ultrasounds. It's just to take the edge off- these procedures do not hurt - there are no needles- but being held on their side with a probe on their chests or belly for 15 minutes can cause anxiety for a lot of patients. So I think it would be a good idea to give her/him a little Trazodone about 2-3 hours before the procedure. It's very safe- nothing to worry about- and I think it would make it a more comfortable experience for her/him. Let us know if you would like to get it filled.

Tooth brushing tips:

-Teeth must be brushed every day to every other day to make a significant impact on dental plaque and calculus buildup. It takes about 2 days for plaque (which is temporary) to turn into calculus (which needs to be removed by dental scaling under general anesthesia)

-Studies have shown only 5 brushes per day are needed on each set of teeth.

-Focus on the outside of the teeth: particularly the large cheek teeth, canines, and incisors (front teeth)

-Toothpaste is recommended (I prefer CET brand), but it is not vital—warm water and the mechanics of brushing make the biggest impact

-Brush your pet’s teeth at a time of day he or she looks forward to: playtime, dinner, or before a walk. Keep the toothbrush near whatever item is used at that time of day as a reminder to yourself and a way to reward your pet after brushing!

Dental chews such as CET Hextra, Greenies, TartarShield, or Checkups can also help keep plaque off of the chewing teeth.

You can reference this website for a list of products that have been thoroughly researched by the VOHC: http://www.vohc.org/

Upper respiratory disease in cats can be caused by viruses (e.g. herpesvirus, calicivirus) or bacteria (e.g. Bordetella, Chlamydophila, and mycoplasma). Viral infections are the most common and are similar to colds in people. Transmission of disease is either through coughing/sneezing particles or via contaminated hands, feeding dishes, or other objects. A history of exposure to other cats is common.  

Supportive care is the most important aspect of treatment.  This involves:

• Keeping the eyes and nose free of discharge with a warm washcloth
• Humidifying the environment (such as taking them into a steamy bathroom (e.g. bathroom with shower running) for 10-15 minutes at a time 2-3 times per day),
• Providing a highly palatable food and fluids. In cats, their appetite is stimulated by their sense of smell. Therefore, warming up canned food or baby food may tempt them to eat. 
• Preventing environmentally-induced stress, which may lengthen the course of the disease. Keep your cat rested and in low-stress situations for at least 2-3 weeks. 
• Cats with nasal congestion may also benefit from non-medicated saline nose drops (e.g. Little Remedies Saline Drops), 1-2 drops once to twice a day for 5-7 days. Please ensure that you do NOT use nasal decongestant drops! 

The course of disease may last several days to several weeks.  It may get worse initially before signs improve. If worsening is noted, your cat should continue to be rechecked as further fluids and other therapy may be needed.  

Exposure to other cats should be limited during the course of disease. 

Many cats will develop a carrier state of the virus which means they can develop intermittent signs of disease and transfer disease to other cats.  Signs can be very subtle or obvious during reoccurrence.

-Please start XXXXXXX on Rx Humulin-N, 10ml bottle or Rx Vetsulin, Give XX units subcutaneously every 12 hours, 5 refills. 

Rx Insulin syringes - 3/10cc, u-100, 31 gauge ultrafine or u-40 Vetsulin syringes.

-- Feed Hill's W/D - Give 1/2 can prior to giving him his insulin. As long as (s)he eats half of that, you can go ahead and give insulin. If eats less than half of the meal, give only half the normal dose of insulin. At the next meal, if (s)he eats less than half again, withhold giving insulin and get in touch with us or the ER.

--If you note weakness, fainting, or seizures (signs of low blood sugar), rub Karo syrup on their lips and get to a vet. 

1. No longer use a crate - if a dog is anxious in the crate, being there will only heighten the anxiety. If they are destructive out of the crate, try to gate or keep them in an area where there is less potential for damage. 
2. No interactions should occur between you and your pet for 30 minutes before departure to help them adapt to you not being present. The only exception would be the presentation of a treat-dispensing device or other long-lasting treat at the time of departure to keep the pet's attention during the departure.
3. Leave the dog a delectable food treat or several food-stuffed toys on departure.
4.  To reinforce relaxed behavior, ignore your dog when arriving at home until they are relaxed.  This may take a while at firs
5. Consider daycare or leaving them with a friend for a few weeks when you go to work while you are working on the next few steps.
6. Desensitize - pull out your keys and put on your coat repeatedly through the day and NOT leave the house.
7. Counter-condition- when desensitizing as above, reward him with treats if he sits and stays for you - this will hopefully make him think the keys and coat are a good thing.
8. Get a DAP diffuser - made by Adaptil - this is a "feel good" pheromone and can be purchased online.
9. Food puzzles and Kongs with frozen peanut butter when you leave to distract him.
10. Trazodone 2 hours before leaving the house- this is an anti-anxiety medication. Give the first dose on a day when you can observe to make sure they don't get too sedate.
11. If no improvement next week, we can discuss Fluoxetine (prozac) or a behavior consult.
12. Check out the book “Don’t Leave Me” by Nicole Wilde
13. Sophia Yin's YouTube series
14. ASPCA Website https://www.aspca.org/pet-care/dog-care/common-dog-behavior-issues/separation-anxiety

Cognitive dysfunction syndrome (CDS) is a neurological degenerative disorder of senior dogs and cats characterized by gradual cognitive decline and increasing brain pathology. Elderly animals are less able to perform a variety of cognitive tasks compared to younger ones. Progression of clinical signs is very gradual and owners observe subtle changes as this occurs.  

Types of behavior that animals can display include:

1)Spatial disorientation/confusion may be manifested as wandering, staring, or moving to unusual places.
2) Altered learning and memory may cause house soiling and lack of response to previously learned commands. In working dogs, a decline in performance may be noted. 
3) Alterations in activity may occur, such as increased purposeless or repetitive activity. Conversely a decline in activity may be noted.
4) Altered social relationships, with decreased or altered interactions or responsiveness to family members may occur.
5) Altered sleep-wake cycles, such as nighttime waking or increased anxiety, irritability or restlessness can be a problem.
6) Decreased perception of or responsiveness to stimuli may lead to decreased interest in eating, walking, playing.

To treat or supportive this condition, there are several medications/supplements to choose from: 

Selegiline (prescription medication)

Morning administration is recommended, particularly in dogs with sleep-wake cycle disturbances.

Clinical efficacy studies supporting selegiline use in CDS were based primarily on owner response to questionnaires, rather than on standardized comparative cognitive testing procedures of treated and untreated patients. Since selegiline may produce nonspecific, low-level hyperactivity by increasing brain catecholamine levels, the "response" observed by owners may not truly be representative of improved cognitive ability.

Response to therapy may be noted within a few days, although typically most owners report improvements within the first 2 weeks of therapy. At one month the response rate was reported to be 77%.

S-adenosylmethionine (supplement – available over the counter or online) was found to be effective in improving clinical signs associated with CDS in a double-blinded, placebo controlled trial.

Senilife – supplement available online – a study performed in 2008 from the university of Toronto did a study in relation to this product.  “Aged dogs demonstrate cognitive decline that is linked to brain aging. The purpose of the present study was to examine if a commercially available nutraceutical supplement that may be neuroprotective and contains phosphatidylserine, Ginkgo biloba, vitamin E, and pyridoxine could improve cognitive function in aged beagles. These findings suggest that the nutraceutical supplement can improve memory in aged dogs.”

Supportive Therapy
Environmental enrichment, such as regular exercise and introduction of new toys, can improve cognitive function and delay cognitive decline.14,15 In a laboratory study of older dogs over a 2-year period, environmental enrichment (e.g. housing with another dog, daily playing with toys) was shown to be an effective tool for task learning. Dogs that were given both dietary and environmental enrichment had the greatest improvement in learning ability when compared to dogs who did not have enrichment.

Consider scheduling an appointment with Insight Animal Behavior: https://www.insightfulanimals.com/our-practice This is a practice of veterinary behaviorists that work with owners to find what triggers their pet's anxiety and how to best manage their anxiety. Additionally, look into training sessions with Kiki Yablon: https://kikiyablondogtraining.com/.

Owner Instructions: 

• Recommend Adaptil collar and plug-ins. Releases a relaxing pheromone. Order from Amazon.
• Recommend Composure treats. Break into pieces.
• Refer to an in-home trainer - Sally Bushwaller or Kiki Yablon.

Management:

Deferential Training:

1.  Teach your dog to be more independent of people

Ignore your pet's attempts to solicit attention since anxious dogs often use personal contact to manage anxiety, and this strategy is not available to your pet when it is away from you. All contact should be on your initiative. ("Nothing in Life is Free")

" All attention is at person's initiation-person begins and ends attention sessions, rather than the dog initiating attention

" No attention on pet demand

" Attention must be earned by the pet by performing a task, such as "Sit"

" Decrease following behavior while the person is at home

See the following links on how to introduce this "Nothing in Life is Free" policy:

http://www.k9deb.com/nilif

http://www.humanesociety.org/animals/dogs/tips/training_nothing_in_life_is_free.html#.U3Kkr4FdUp0

Avoid situations in which your pet reacts fearfully or aggressively. This will help to prevent continued rehearsal of problem behaviors and will also help to reduce stress and anxiety. 

· Avoid direct encounters with unfamiliar people or dogs when possible. While out on walks, cross the street, change direction, or move off of the sidewalk to maintain a safe distance.

· Avoid high traffic streets or areas where people and off leash dogs congregate.

· If XXXXX reacts to a person or dog despite your best efforts, move him away as calmly and quickly as possible.

When visitors are over:

·  We recommend your guests ignore XXXXXX and avoiding forced contact. Please instruct them not to stare at, approach, reach toward, or try to pet him, even if he approaches them. You can toss treats on the ground towards XXXXXX while guests are present.

· Ask your guests to let you know before they move around. Prior to your guest moving, call your pet over to you, give them a cue (e.g. sit, shake) and a treat. Repeat this when your guest returns from a different room.

Behavior Modification:

Counterconditioning to other dogs and people on walks: The goal of this exercise is to change your pet’s association with triggers. This is the first step in behavior modification.

· For this exercise to be successful, you need to maintain a safe distance from your pet’s triggers. A safe distance is the distance at which your pet does not growl, bark, or lunge at the trigger and can take treats.

· When you see a trigger at a safe distance, begin feeding your pet treats. Your pet does not have to perform a particular behavior aside from not growling, barking, or lunging at the trigger. Continue feeding treats until the trigger is out of sight. Repeat for every trigger you see at a safe distance.

· After several repetitions of this exercise, you should see your pet look at you when they see a trigger, in anticipation of a treat. This is a great sign of progress.

· Should your pet react before you have a chance to give them a treat or if your pet is not responding to your cues or taking the treats, increase your distance from the trigger.

· Here is a great video that explains the learning principles behind this technique:

o  https://www.sfspca.org/preventing-problem-behaviors-introducing-your-dog-new-situations

Other tips:

-Avoid the use of punishment, including verbal or physical corrections (collar or leash corrections, prong collar, electronic collars) in response to your pet’s behavior. While these corrections may temporarily suppress the problem behavior in the moment, if you have to use them regularly in the problem situation, they are not effective teaching tools. Aversive corrections also have many side effects and make anxiety, 

-Monitor XXXXXX for subtle signs of fear, anxiety, or conflict. The goal is to recognize subtle signs of fear and intervene by ending the interaction or creating space between your pet and the trigger before they escalate to more fearful or aggressive behavior.

· “Zoom Room Guide to Dog Body Language” http://www.youtube.com/watch?v=00_9JPltXHI

· “What Your Dog is Desperately Trying To Tell You” http://www.youtube.com/watch?v=bstvG_SUzMo

Owner Instructions: Watch XXX closely overnight, and if s/he seizures again, please get him/her to the ER. 

If the bloodwork is normal, we are going to decide if we need to be on anti-seizure medication based on several criteria that you will monitor for. Look for:

1) 2 or more seizures in a 6 month period

2) Seizure lasting more than 5-6 minutes

3) Cluster of multiple seizures in a 24 hour time period

4) Blindness or aggression in the post-ictal phase (period of time right after the seizure), or a post-ictal phase lasting more than 24 hours.

In addition, next time there is a seizure, once you make sure you ands/he are safe, start to video the episode so you can email us the file and we can see it as well. Also start to time each seizure in the future. If one ever reaches 5 minutes, s/he needs to get to a vet if you can transfer XXXX safely. 

1) Keep XXXXX separated from any other cats in a room that is easily cleaned.

2) Oral Terbinafine 

3) Order Douxo Chlorhexidine Mousse online - make sure Climbazole is one of the ingredients. Use this daily on days XXXX is not being bathed.

4) Medicated baths twice a week.

5) Frequently clean the room being used - use swiffers to clean and/or a bleach solution (diluted 1:32 with water) - while using bleach, temporarily keep XXXX outside the bathroom in a carrier while it dries (and clean out the carrier each time)

-From there, we will monitor. After at least 1 month, we will recheck a Ringworm PCR to see if responding.

From a 2/24/21 discharge at MedVet: Masses of the spleen are common in older dogs. Approximately 1/2 to 2/3 of these are malignant tumors, the most common being hemangiosarcoma. The other common cause is a splenic hematoma. Potential complications

related to this condition and its treatment include incisional infection/dehiscence, cardiac arrhythmias, thrombosis, coagulopathies, anesthesia-related complications (minor to life-threatening), and less commonly, death. Ideally staging should be performed through

complete blood work, thoracic radiographs and abdominal ultrasound. Consideration should also be given to echocardiogram, to evaluate the heart for metastasis. Macroscopic metastases are sometimes seen at surgery and we will call intraoperatively to determine if the owners elect euthanasia under anesthesia or to continue. If hemangiosarcoma is diagnosed, the average survival is 3-4 months with surgery alone, and 6 to 8 months with postoperative chemotherapy. If a benign lesion is present, surgery should curative.