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1 Shield Stone Pet Hospital 1610 East Shields Avenue Fresno, CA Patient Chart Printed: at 12:21p CLIENT INFORMATION Name JOSE SILVA (12823) Address 3940 N MAROA FRESNO, CA Phone Balance 0.00 Owner_DOB Owner_Gender M PATIENT INFORMATION Name DEAN Species Canine Sex Male, Neutered Breed Hound Birthday Age 6y ID Rabies Color Tri Color Weight lbs Reminded (none) Codes HEALTH HISTORY SUMMARY Date Diagnosis READ - Refer out Further Tx DEAN's weight history (in lbs) MEDICAL HISTORY YH COMM2 Chart Sent: ed Daughter called request chart. ed to: riorrisilva@hotmail.com HS READ READ - Refer out Further Tx YH COMM2 Chart Sent: ed ed to Veterinary Specialty & O, Jose Silva: fresnovetspecialty@gmail.com, joseasilva@hotmail.com ed: Entire Avimark Chart & Blood Work BLOOD PRESSURE CHECK. DISC1 DISCOUNT IVLSO Requisition Test Result Flag Normal Range Measure Low High ProCyte_Dx :09a RBC 2.30 L M/µL HCT 15.2 L % HGB 4.9 L g/dl

2 Date: , Time: 12:21p Page: 2 MCV fl MCH pg MCHC g/dl RDW 22.4 H % %RETIC 15.5 % RETIC H K/µL WBC K/µL %NEU 62.4 % %LYM 23.6 % %MONO 8.6 % %EOS 5.3 % %BASO 0.1 % NEU K/µL LYM K/µL MONO 1.18 H K/µL EOS K/µL BASO K/µL PLT 92 L K/µL MPV 19.7 H fl PDW fl PCT % Test Result Flag Normal Range Measure Low High Catalyst_One :16a GLU mg/dl CREA mg/dl BUN mg/dl BUN/CREA 19 PHOS mg/dl CA mg/dl TP 4.6 L g/dl ALB 1.7 L g/dl GLOB g/dl ALB/GLOB 0.6 ALT U/L ALKP U/L GGT U/L TBIL < mg/dl CHOL 13 L mg/dl Na mmol/l K mmol/l Na/K 39 Cl mmol/l Osm Calc 298 mmol/kg Attachments\12823\DEAN\ _085603_446.pdf YH 5180 Heartworm/Borrelia/Ehrlichia/Anaplasma INHOUS6 CBC/CHEM 15/LYTE HS APPT$ Appointment notes for YH RECHECK HS VI$IT Patient check-in

3 Date: , Time: 12:21p Page: 3 Age: 6y Weight: Temp: Respiration: Pulse: CRT: <1 secs. BCS: 5.00 / 9.00 SUBJECTIVE SECTION OBJECTIVE SECTION has been eating drinking okay still bleeding from the nose the owner mentioned that he found ticks and removed and possible access to foxtails in the yard Appearance: QAR Hydration:Adequate Hydration. Eyes: Symmetric eye ball position, no ocular discharge, normal palpebral reflex OU, Normal gaze OU, pupils symmetric and responsive, clear Corneas OU, Clear anterior chambers OU. complete eye evaluation was not performed. Ears: No discharge or erythema both ears. Nose: Moist, airflow symmetric bilaterally, epistaxis from bilateral nostril, mainly from right nostril. hyperkeratosis on nose Oral Cavity: Mucous membranes pale pink, moist, normal capillary refill time. No foreign bodies appreciated. Dentition mature, complete dental evaluation was not performed. Skin: no erythema or alopecia or excoriation. No external parasites noted Heart/Lung : Normal sinus rhythm, synchronous femoral pulses bilaterally, no murmurs noted. No crackles, wheezes in lung fields bilaterally, normal respiratory rate and effort. Abdomen: Mild tension without pain. Soft palpable bladder. No palpable masses or organomegaly. genitourinary/rectal: No mammary masses noted. External anatomy visually normal./ External anatomy visually normal. Digital rectal exam not performed. musculoskeletal: Ambulatory, no lameness or weakness noted. Neurologic: normal mentation. Normal gait and balance. LN: No peripheral lymph node enlargement. ASSESSMENT SECTION cbc - regenerative anemia, thrombocytopenia chem - hypoalbuminemia, decreased total protein blood pressure with Oscillometer - sys/dia - 144/53, 133/69, 105/67, 112/53 slide autoagglutination - no agglutination noted 4dx snap test- negative epistaxis ddx epistaxis - localized - nasal tumor, trauma, fungal rhinitis ( aspergillosis or cryptococcus or open), nasal foreign body oronasal fistular - systemic - thrombocytopenia, coagulopathy or vasculitis or hypertension ddx thrombocytopenia - increased destruction/utilization - hemorrhage, immune-mediated thrombocytopenia, microangiopathic or neoplasia - decreased production - bone marrow disorder or ehrlichiosis ddx for regenerative anemia, blood loss anemia - trauma, coagulopathy, rodenticide toxicity or platelet disorder toxicity

4 Date: , Time: 12:21p Page: 4 infectious microangiopathic ( neoplasia or vasculitis) hemolytic anemia ddx PLAN SECTION considering severe regenerative anemic condition, refer to emergency specialist hospital for stabilization and further treatment recommended Fungal agents titer,pt-ptt, radiographs the owner declined at this point. After stabilization, seemed need rhinoscopic exam under general anesthesia as well. DIAGNOSTIC PLAN RECHECK YH VIT K CHEW 50MG # GIVE 3 TABLET ONCE DAILY DOXYCYCLINE 200MG CHEWS # GIVE 1 CHEW EVERY 12 HOURS BY MOUTH Panacur 40 # GIVE 2 PACKAGE ONCE A DAY FOR 3 DAYS. MIX WITH CANNED FOOD HS APPT$ Appointment notes for EXAM: WALK IN/SAME DAY APPT VI$IT Patient check-in Age: 6y Weight: Respiration: Pulse: CRT: <1 secs. BCS: 5.00 / 9.00 SUBJECTIVE SECTION OBJECTIVE SECTION NO RODENTICIDE IN THE PROPERTY AS PER THE OWNER MOSTLY STAY IN SIDE AND PLAY IN THE YARD Eating/Drinking ok. No Vomiting/Diarrhea/Sneezing/Coughing. Appearance: BAR Hydration:Adequate Hydration. Eyes: Symmetric eye ball position, no ocular discharge, normal palpebral reflex OU, Normal gaze OU,

5 Date: , Time: 12:21p Page: 5 pupils symmetric and responsive, clear Corneas OU, Clear anterior chambers OU. complete eye evaluation was not performed. Ears: No discharge or erythema both ears. Nose: Moist, EPISTAXIS from right nostril,hyperkeratosis on nose, airflow symmetric bilaterally. Oral Cavity: Mucous membranes pink, moist, normal capillary refill time. No foreign bodies appreciated. Dentition mature, complete dental evaluation was not performed. Skin: no erythema or alopecia or excoriation. No external parasites noted Heart/Lung : Normal sinus rhythm, synchronous femoral pulses bilaterally, no murmurs noted. No crackles, wheezes in lung fields bilaterally, normal respiratory rate and effort. Abdomen: Mild tension without pain. Soft palpable bladder. No palpable masses or organomegaly. genitourinary/rectal: No mammary masses noted. External anatomy visually normal./ External anatomy visually normal. Digital rectal exam not performed. musculoskeletal: Ambulatory, no lameness or weakness noted. Neurologic: normal mentation. Normal gait and balance. LN: No peripheral lymph node enlargement. ASSESSMENT SECTION ddx thrombocytopenia from decreased production( bone marrow disorder) or increased destruction ( primary /secondary IMHA) or increased consumption or thrombocytopathy or coagulopathy or high blood pressure or foreign body obstruction or nasal neoplasia or nasal aspergillus or cryptococcus or bacterial infection or nasal parasites or oronasal fistula or open PLAN SECTION recommended blood pressure check, blood and PT-PTT check, aspergillosis serology informed the owner to recheck tomorrow for futher diagnostic tests TREATMENT PLAN VIT K CHEW 50MG GIVE 3 TABLET ONCE DAILY Panacur 40 1 PACKAGE ONCE A DAY FOR 3 DAYS. MIX WITH CANNED FOOD. DOXYCYCLINE 200MG CHEWS GIVE 1 CHEW EVERY 12 HOURS BY MOUTH EXAM: WALK IN/SAME DAY APPT HS 2360 Examination