C09977506 / invoice 10000

E/d/u/d okcough 3 times,  lying in crate once, another time and then after eating very fasttoilet trainign ot completediscuss pee mats high value treatrv 4-6 weeks to discus cough, get another video, intense toilet trianingwound excellentminor swellingat 10 days post op can start exercise and bathing again

doing ok overnight, bit sleepy in general. crated overnight. doing ok this morning, O happy with how she is this morning, ate last night and this morning. O going to keep cage rested and advised not letting her run around. keeping cone on.ssm

Prega bloods test wnlPrega check mostly temproary teeth presentChest ausc wnlConscious xrays not positbleace/methadone>> light sedationchest radiographs3 viewslaterals and vdCardiac silhouette wnlDiaphragm intactOesophagus wnlMediastum seem wnlTrachea- wnlDiffuse interstitial pattern throughout lung fieldsIV cathter placedHartmans @ 2M periopAlfaxone induction and intubate s4.5 lubricatedInitally 3.5 used, too smallTonsils evenly enlargedSoft palate doesnt appear too long or abnormalNo xs saliva or discharge seenMaintain iso gaStandard midline approachLocate and ligate both ovarian ligamentsLocate an dligate uterine birfucaitonClose  standard 3 layers withi/dermals3-0 pds used ligatures, suturesLoxicom 0.1ml SC on recoveryCough is 1-2 x weeklyVideo of cough seenURT noises are more pronounced than classical cough- some snorting, swallowing, possibly some huffing cough seen, no overt chest effort seenURT exam under Ga>wnl, tonsilar enarlgementNote a small vomit pre sedationSmall regurg on recovery, tube still in place, was upright and held in upright head positionSome mucous at tip of et tubeOpen assessment re respiratory noise- some URT component to noises, however lung rads are not normalConsider GERs, tracheal collapse not rule dout with sec pulm changes, pneumonititis causesPreference for monitoring at this stage, repeat xrays in 4-6 weeks if cough still presentAlternative is furthe rinvestigaiton now via scoping, referral opinion on xrays, videoDiscusses iwth owners- will monitor initially