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Veterinary Medical Teaching Hospital Texas A&M University (979) 845-2351 www.cvm.tamu.edu Zoological Medicine & Surgery Discharge Summary Owner: Vicky Keahey 3430 Sky View Dr. Wylie, TX 75098 Home Phone: 972-442-6888 Admission Date: August 26, 2010 Patient: #194387, Cody DOB: 00/00/0 Weight: 122.14 lbs Attending Clinician: Sharman Hoppes, DVM Discharge Date: August 26, 2010 Senior Clinician: Sharman Hoppes, DVM Student: Megan Ohlenforst, 4VM Referring Veterinarian: Cody was admitted to the Texas A&M University Veterinary Medical Teaching Hospital on August 26, 2010 . Presenting complaint: labored breathing History: Cody, an eleven year old male cougar, presented to the Zoo Medicine service on 8/26/10 for labored breathing of four days duration. On 4/13/10, Cody was taken to the rDVM for anorexia and vomiting; thoracic radiographs were taken and were clear and bloodwork (CBC/Chemistry) showed no significant abnormalities. Since then, he has had recurrent episodes of anorexia. In June 2010 Cody had a soft tissue abscess on his chin which was treated with amoxicillin. The abscess returned in July 2010 and was treated successfully with amoxicillin again. On 8/23/10 he was taken to the rDVM for acting aggressively towards Ms. Keahey, which is unusual for Cody. Cody was anesthetized for chest films, which revealed a large mass and pleural fluid. Since waking up from anesthesia on 8/23/10, he has had very labored breathing. On 8/24/10 he was started on 2ml of Furosemide twice daily and has been drinking lots of water since. Since Monday, he has been more lethargic than normal, and has been laying down much more than normal but is still responsive and easily roused. He was referred to Texas A&M for further diagnostics and possible surgery. Since April, he has lost approximately 40 lbs. Cody is housed outside in a large enclosure with two other cougars and shares fencing with nine more big cats. He eats 1.5 lbs of a vitamin fortified ground beef, 3 strips of horse meat, and 2 chicken drumsticks daily. He was vaccinated in 10/09 with rabies and FVRCP vaccines. He has not been tested for FIV/FeLV. Cody received his monthly Frontline and Capstar approximately 2 weeks ago. Ms. Keahey has had Cody since 2005 and he has had no prior illnesses or surgeries since then. He was reportedly intact when Ms. Keahey obtained Cody, but he appears to have been neutered. The previous owners had Cody declawed in all four paws. Physical Examination: R: 64 rpm Wt: 123 lbs BCS:4/9 On physical exam, Cody is quiet, alert, and responsive. Breathing is very rapid and labored, with an abdominal component. Eyes, ears, and nostrils all appear clear. Cody is thin, and his spine and pelvic bones are easily visible. Respiration increased with activity (up to ~96rpm after the first IM injection). Flow by oxygen was provided upon arrival and continued until anesthetic induction Diagnostic Tests & Results: FIV/FeLV combo test: Code Name Result FIV/FELV COMBO FIV/FELV COMBO Negative Thoracic Fluid Cytology: CYTOLOGIC FINDINGS: A direct and concentrated smear prepared from the pleural fluid are examined. The smears are highly cellular and contain numerous nucleated cells and occasional erythrocytes in a highly proteinaceous and granular background with frequent lysed cells and extracellular bacterial rods and cocci. The nucleated cells are composed predominantly of markedly degenerate neutrophils with occasional macrophages. The neutrophils often contain phagocytized bacterial cocci and/or rods that range from small, short rods to long, thin, filamentous rods. The macrophages are often moderately vacuolated but do not appear to display cytophagia. No neoplastic cells are identified. INTERPRETATION: Marked septic suppurative exudate. COMMENTS: The markedly elevated nucleated cell count and protein concentration are consistent with an exudate that is characterized mainly by degenerate neutrophils. The mixed population of bacteria is consistent with infection secondary to a foreign body or a bite wound. A Gram stain reveals that the cocci and both forms of rods are Gram positive. Due to the highly proteinaceous background of the smear, Gram negative bacteria are not recognized but cannot be ruled out entirely. Filamentous rod shaped bacteria are often concerning for anaerobic bacteria, Nocardia spp, or Actinomyces spp; however, this cannot be determined based on cytology and thus aerobic and anaerobic bacterial culture and sensitivity testing is indicated. Test Result Reference Unit Pre-Centrifugation Color Volume Submitted Pre-Centrifugation Transparency Light red 1.5 ml Opaque WBC (/ul) 134000 ul RBC (/ul) 34000 ul Post-Cent. Supernant Color Straw Post-Cent. Supernant Transparency Slightly hazy Total Protein (TS-g/dl) 7.2 g/dl Fibrinogen-Heat 300 mg/dl Chest Radiographs: 3-view study Pleural fluid and free gas visible; large mass visible in the left caudal lung lobe. Irregular margins of lung lobes. ICU NOVA arterial analysis: BUN- error, high (too high to read) Creatinine- 10.2 ICU NOVA venous analysis: BUN- error, high (too high to read) Creatinine- 10.5 Abaxis vetscan analysis: BUN- 170 Creatinine- 10.2 Chemistry profile: Test Result Glucose 180. Reference Unit mg/dl Lactic Acid 46.3 mg/dl Cholesterol 64. mg/dl Blood Urea Nitrogen 178. mg/dl Creatinine 10.0 mg/dl Magnesium 2.7 mg/dl Calcium 7.4 mg/dl Phosphorus 12.7 mg/dl Total Protein 5.1 g/dl Albumin 1.4 g/dl Globulin 3.7 g/dl Alanine Aminotransferase 10. U/L Alkaline Phosphatase 20. U/L Gamma Glutamyltransferase <10. U/L Total Bilirubin <.1 mg/dl Sodium 143. mmol/L Potassium 3.5 mmol/L Chloride 106. mmol/L Enzymatic Carbon Dioxide 15. mmol/L Anion Gap (Calculated) 25. mmol/L Diagnosis: Septic suppurative exudate with mixed bacterial cell population; likely due to cat bite; possible foreign body. Treatment: Sedated with midazalam, dexdormator and Ketamine with pole syringe, intubated and placed on Sevoflurane, placed two 18 guage IV cathetors and placed on a respiratory ventilator. Blood colected for FELV, FIV and Chemistry profile. Radiographs revealed pleural effusion, collapsed lungs and masses in lungs. 2.5 liters of bloody purulant fluid was removed from the thoracic cavity per thoracocentesis. Blood work revealed negative Felv and FIV testing, but acute renal failure was present. Azotemia present after > 2 liters of fluids given IV. Discussed thoracic surgery and possible lung lobectomy, but very grave prognosis, especially with renal failure present. Due to grave prognosis, owner elected euthanasia. Necropsy revealed severe abscessation of both caudal lung lobes with fibrous adhesions. ****IF YOU HAVE ANY QUESTIONS OR PROBLEMS, PLEASE DO NOT HESITATE TO CALL – (979) 845-2351*** _____________________________ Clinician _____________________________ Student