C09979668 / invoice 10000

Reason for Presentation: Laryngeal exam and lump removal from back left foot.History: O reports no further laryngeal episodes at all, has been eating, drinking, playing and breathing well. O would like "cyst" on foot removed as well.Examine: QAR, no stertor, stridor, dyspnoea at all. Thoracic ausc and abd palp nad. No response to tracheal pinch. Soft sweling on dorsal aspect of left metatarsals.Anaesthesia: Premedication: Acepromazine 0.02mg/kg and methadone 0.3mg/kg IMInduction: Alfaxalone 1mg/kg IVMaintenance: Isoflurane 1-2%IVFT: Hartmanns 5ml/kg/hrExamine: Laryngeal examination: no oral swellings/ inflammation. Tonsils in crypts. Soft palate only just past epiglottis. No everted saccules. Vocal fold and epiglottis nad. Scope retroflexed into caudal nasal passage- no polyp/ mass inflammation evident.Surgery: Swelling over dorsal aspect of foot 1cm x 2cm x 1 cm. Skin incised over mass (too large to attempt excision). Swelling coming from between metatarsals. Blunt dissection around mass and abnormal tissue excised and submitted for histopathology. NB amputation will be required if not benign. Closed 3/0 pds in subcutaneous layers and 3/0 premilene in skin. Bandage applied post operatively- to be removed in 2-5 days.Meloxicam adminstered on recoery and dispensed for home.    Vital Signs    

Reason: Intermittent Cough/retch And Strange Jerky BehavioAppointment Notes: wants to see PMC onlyHistory:- Occasional episodes of trying to regurgitate, increasing in frequency- Episodes involve hacking, panic, and ingestion of non-food items (dirt, sticks, hair)- No vomiting unassociated with gagging episodesExamination:- Lungs: Clear- Oral examination: Enlarged, elongated soft palateDIAGNOSIS- Possible soft palate issues causing obstruction behind epiglottis- Potential lymph node enlargement or cancer in tonsil area- Possible vocal fold paralysis or saggingPlan:1. Perform endoscopy to examine soft palate, pharyngeal area, larynx, and vocal folds2. Consider biopsy of lymph nodes and pharyngeal area if no obvious masses are detected during initial examination3. Possible soft palate resection if sagging is observed4. Pre-anaesthetic evaluation to ensure safety for anaesthesia5. Provide cost estimate for worst-case scenario including biopsies and potential surgeries6. Schedule appointment with Sasha or John for detailed examination and possible surgical intervention    Vital Signs    Weight: 8.1;