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Creekside Animal Hospital Schuyler Avenue Lafayette, TN Sagamore Parkway W West Lafayette, TN To: Whom It May Concern, attention [redacted] Re: Case ID [redacted] , [redacted] Please find enclosed the following records for our past patient, "Piper", a week old Pomeranian puppy owned by [redacted] ***Insummary the following situation occurred: On 11109/Piper was presented to us by the owner's mother for a leg injuryThe owner had told us over the phone that she would be able to pay for the exam, but would need to make payments on any other charges that may be incurred during the visitPiper reportedly was hit from above by a dishwasher doorShe was three legged lame at that time when examined by DrT [redacted] Her stifle was swollen and x-rays were taken of the area to determine if anything was brokenThe radiographs did not reveal any obvious fractures and a soft tissue injury was suspected given the recent traumaThere was no disruption of skin during this examShe was sent home with a nonsteroidal anti-inflammatory appropriate for a small dog to relieve pain and swelling On 11116/The owner called and spoke to our receptionist stating that Piper is now "licking her leg and now has a sore as well as licking her private area"The owner questioned if she could be in heat She also mentioned that Piper had some constipationOur registered veterinary technician, Tanika, returned her call and obtained more informationThe owner had found drops of blood near her "private areas"and described her leg wound from licking to be "like rug burn"She was scheduled for a recheck appointment the next day with DrK*** 11/17/ Dr J [redacted] reexamined Piper and reviewed the radiographs with the ownerThe owner mentioned that Piper's eyes looked red yesterday but they were not abon her exam on this dayDr J [redacted] discussed the fact that the stifle was still swollen and there was an audible "click"upon manipulation of the stifleThere was bruising along the inside of the inner left thigh area and an abrasion with a scab along the medial hock of that leg secondary to licking (no punctures, just more of what I would also have described as a rug burn)Piper was very wiggly for her exam during this visit and owner had to help hold her still so that an exam could be done for the puppyShe was not acting ill at any time during her visit, just lameDr J [redacted] con.firmed with the owner that there could not be any rodenticide poisoning possibility given the bruise and confirmed that there was no other bruising anywhere on her body which there was notThe owner had requested that we shave her "potty patch" area as she had seen some reddish brown liquid around her rear end the day before and assumed that she was in heatNo blood or brown discharge was found during this examination but also no enlargement of the vulva to indicate estrusA rectal exam was not performed due to the small size of the patient (pounds)It was discussed that this could possibly be a result of expression of her anal sacs, or possibly the nonsteroidal anti-inflammatory causing this, it could have been some irritation of the intestines secondary to the recent constipation which the owner had witnessedRegardless, if this reoccurs she should stop the medication and call usSome canned pumpkin was also recommended if the pup had any further episode of constipation as this gentle and natural laxative would be safe for her small sizeDr J [redacted] was concerned with her stifle injury given the "click"and offered a referral to an orthopedic specialist but this was declined by owner at that timeSince Piper had started to chew on her skin and an abrasion was now present, an antibiotic was prescribed at that time11/17/ Just a couple of hours later, the owner called to report that the pup had been left in its kennel and later found to be foaming at the mouth and unresponsiveWe immediately e-mailed our records and a copy of the radiographs to the [redacted] Emergency ServiceUnfortunately, the puppy was dead upon arrivalAccording to the doctor that called us from [redacted] Emergency Service, a necropsy was offered and declined by the ownersReceipts for services rendered are also included for your review: Initial visit on 11/9/ 16: examination, radiograph and NSAID totaled $Client left a $payment Second visit on 11/no charge for the recheck examination and $paid for the antibiotic 11/30/client paid on account the remainder of balance due of $Total of both visits $and current balance due is $It is very unfortunate that this puppy died unexpectedly The clients claim, however, that the puppy died of sepsis is unfoundedThere was no skin wound when initially seen and antibiotics were started at the time of the second visit when the puppy was found to have an abrasion from lickingSepsis is an overwhelming systemic infection which would have certainly made this puppy feel ill and it was so wiggly during the exam on the day of it's passing that it certainly did not act illJudicious use of antibiotics when not warranted is not only in the best interest of the patient but also is in compliance with the standards of veterinary careIt is my opinion that antibiotics would not have saved this puppy and the death was not related to sepsisItwould have been very helpful to have had a necropsy performed to determine the cause of death in this puppy, but this was not doneIt is always very sad to lose a pet, especially one that is so young and energetic just hours before, but this pet did receive appropriate veterinary care and why the puppy passed will always remain undeterminedPlease feel free to call us if you have any further questionsWarmest regards, Pamela LJ [redacted] , DVM

Creekside Animal Hospital Schuyler Avenue Lafayette, TN Sagamore Parkway W West Lafayette, TN To: Whom It May Concern, attention *** *** Re: Case ID ***, *** ** *** Please find enclosed the following records for our past patient, "Piper", a week old
Pomeranian puppy owned by *** ***Insummary the following situation occurred: On 11109/Piper was presented to us by the owner's mother for a leg injuryThe owner had told us over the phone that she would be able to pay for the exam, but would need to make payments on any other charges that may be incurred during the visitPiper reportedly was hit from above by a dishwasher doorShe was three legged lame at that time when examined by DrT***Her stifle was swollen and x-rays were taken of the area to determine if anything was brokenThe radiographs did not reveal any obvious fractures and a soft tissue injury was suspected given the recent traumaThere was no disruption of skin during this examShe was sent home with a nonsteroidal anti-inflammatory appropriate for a small dog to relieve pain and swelling On 11116/The owner called and spoke to our receptionist stating that Piper is now "licking her leg and now has a sore as well as licking her private area"The owner questioned if she could be in heat. She also mentioned that Piper had some constipationOur registered veterinary technician, Tanika, returned her call and obtained more informationThe owner had found drops of blood near her "private areas"and described her leg wound from licking to be "like rug burn"She was scheduled for a recheck appointment the next day with DrK*** 11/17/2016 Dr J*** reexamined Piper and reviewed the radiographs with the ownerThe owner mentioned that Piper's eyes looked red yesterday but they were not abon her exam on this dayDr J*** discussed the fact that the stifle was still swollen and there was an audible "click"upon manipulation of the stifleThere was bruising along the inside of the inner left thigh area and an abrasion with a scab along the medial hock of that leg secondary to licking (no punctures, just more of what I would also have described as a rug burn)Piper was very wiggly for her exam during this visit and owner had to help hold her still so that an exam could be done for the puppyShe was not acting ill at any time during her visit, just lameDr J*** con.firmed with the owner that there could not be any rodenticide poisoning possibility given the bruise and confirmed that there was no other bruising anywhere on her body which there was notThe owner had requested that we shave her "potty patch" area as she had seen some reddish brown liquid around her rear end the day before and assumed that she was in heatNo blood or brown discharge was found during this examination but also no enlargement of the vulva to indicate estrusA rectal exam was not performed due to the small size of the patient (pounds)It was discussed that this could possibly be a result of expression of her anal sacs, or possibly the nonsteroidal anti-inflammatory causing this, it could have been some irritation of the intestines secondary to the recent constipation which the owner had witnessedRegardless, if this reoccurs she should stop the medication and call usSome canned pumpkin was also recommended if the pup had any further episode of constipation as this gentle and natural laxative would be safe for her small sizeDr J*** was concerned with her stifle injury given the "click"and offered a referral to an orthopedic specialist but this was declined by owner at that timeSince Piper had started to chew on her skin and an abrasion was now present, an antibiotic was prescribed at that time11/17/2016 Just a couple of hours later, the owner called to report that the pup had been left in its kennel and later found to be foaming at the mouth and unresponsiveWe immediately e-mailed our records and a copy of the radiographs to the *** Emergency ServiceUnfortunately, the puppy was dead upon arrivalAccording to the doctor that called us from *** Emergency Service, a necropsy was offered and declined by the ownersReceipts for services rendered are also included for your review: Initial visit on 11/9/ 16: examination, radiograph and NSAID totaled $Client left a $payment Second visit on 11/no charge for the recheck examination and $paid for the antibiotic 11/30/client paid on account the remainder of balance due of $88.49. Total of both visits $and current balance due is $ It is very unfortunate that this puppy died unexpectedly. The clients claim, however, that the puppy died of sepsis is unfoundedThere was no skin wound when initially seen and antibiotics were started at the time of the second visit when the puppy was found to have an abrasion from lickingSepsis is an overwhelming systemic infection which would have certainly made this puppy feel ill and it was so wiggly during the exam on the day of it's passing that it certainly did not act illJudicious use of antibiotics when not warranted is not only in the best interest of the patient but also is in compliance with the standards of veterinary careIt is my opinion that antibiotics would not have saved this puppy and the death was not related to sepsisItwould have been very helpful to have had a necropsy performed to determine the cause of death in this puppy, but this was not doneIt is always very sad to lose a pet, especially one that is so young and energetic just hours before, but this pet did receive appropriate veterinary care and why the puppy passed will always remain undeterminedPlease feel free to call us if you have any further questions Warmest regards, Pamela LJ***, DVM

Creekside Animal Hospital 2840  Schuyler Avenue Lafayette, TN 47905180 Sagamore Parkway W West Lafayette, TN 47906 To: Whom It May Concern, attention [redacted] Re: Case ID [redacted] Please find enclosed the following records for our past patient, "Piper", a 22 week old...

Pomeranian puppy owned by [redacted]. Insummary the following situation occurred:   On 11109/2016 Piper was presented to us by the owner's mother for a leg injury. The owner had told us over the phone that she would be able to pay for the exam, but would need to make payments on any other charges that may be incurred during the visit. Piper reportedly was hit from above by a dishwasher door. She was three legged lame at that time when examined by Dr. T[redacted]. Her stifle was swollen and x-rays were taken of the area to determine if anything was broken. The radiographs did not reveal any obvious fractures and a soft tissue injury was suspected given the recent trauma. There was no disruption of skin during this exam. She was sent home with a nonsteroidal anti-inflammatory appropriate for a small dog to relieve pain and swelling.   On 11116/2016 The owner called and spoke to our receptionist stating that Piper is now "licking her leg and now has a sore as well as licking her private area". The owner questioned if she could be in heat.   She also mentioned that Piper had some constipation. Our registered veterinary technician, Tanika, returned her call and obtained more information. The owner had found drops of blood near her "private areas"and described her leg wound from licking to be "like rug burn". She was scheduled for a recheck appointment the next day with Dr. K[redacted].   11/17/2016  Dr J[redacted] reexamined Piper and reviewed the radiographs with the owner. The owner mentioned that Piper's eyes looked red yesterday but they were not abnormal on her exam on this day. Dr J[redacted] discussed the fact that the stifle was still swollen and there was an audible "click"upon manipulation of the stifle. There was bruising along the inside of the inner left thigh area and an abrasion with a scab along the medial hock of that leg secondary to licking (no punctures, just more of what I would also have described as a rug burn). Piper was very wiggly for her exam during this visit and owner had to help hold her still so that an exam could be done for the puppy. She was not acting ill at any time during her visit, just lame. Dr J[redacted] con.firmed with the owner that there could not be any rodenticide poisoning possibility given the bruise and confirmed that there was no other bruising anywhere on her body which there was not. The owner had requested that we shave her "potty patch" area as she had seen some reddish brown liquid around her rear end the day before and assumed that she was in heat. No blood or brown discharge was found during this examination but also no enlargement of the vulva to indicate estrus. A rectal exam was not performed due to  the small size of the patient (7 pounds). It was discussed that this could possibly be a result of expression of her anal sacs, or possibly the nonsteroidal anti-inflammatory causing this, it could have been some irritation of the intestines secondary to the recent constipation which the owner had witnessed. Regardless, if this reoccurs she should stop the medication and call us. Some canned pumpkin was also recommended if the pup had any  further episode of constipation as this gentle and natural laxative would be safe for her small size. Dr J[redacted] was concerned with her stifle injury given the "click"and offered a referral to an orthopedic specialist but this was declined by owner at that time. Since Piper had started to chew on her skin and an abrasion was now present, an antibiotic was prescribed at that time. 11/17/2016  Just a couple of hours later, the owner called to report that the pup had been left in its kennel and later found to be foaming at the mouth and unresponsive. We immediately e-mailed our records and a copy of the radiographs to the [redacted] Emergency Service. Unfortunately, the puppy was dead upon arrival. According to the doctor that called us from [redacted] Emergency Service, a necropsy was offered and declined by the owners. Receipts for services rendered are also included for your review: Initial visit on 11/9/ 16: examination, radiograph and NSAID totaled $138.49 Client left a $50 payment Second visit on 11/1712016 no charge for the recheck examination and $11.77 paid for the antibiotic 11/30/2016 client paid on account the remainder of balance due of $88.49. Total of both visits $150.26 and current balance due is $0 It is very unfortunate that this puppy died unexpectedly.  The clients claim, however, that the puppy died of sepsis is unfounded. There was no skin wound when initially seen and antibiotics were started at the time of the second visit when the puppy was found to have an abrasion from licking. Sepsis is an overwhelming systemic infection which would have certainly made this puppy feel ill and it was so wiggly during the exam on the day of it's passing that it certainly did not act ill. Judicious use of antibiotics when not warranted is not only in the best interest of the patient but also is in compliance with the standards of veterinary care. It is my opinion that antibiotics would not have saved this puppy and the death was not related to sepsis. Itwould have been very helpful to have had a necropsy performed to determine the cause of death in this puppy, but this was not done. It is always very sad to lose a pet, especially one that is so young and energetic just hours before, but this pet did receive appropriate veterinary care and why the puppy passed will always remain undetermined. Please feel free to call us if you have any further questions. Warmest regards,   Pamela L. J[redacted], DVM