C09985577 / invoice 10000

Reason: Coughing/Seizures, Fluoxetine Script, Appointment Notes: Coughs> farts> trachea collapse> faints> seizureCoughs with exercise and arousal e.g walks and when O come homeHistory: current medsTrilostane 60mg bid for HCA under JB sashFluotixne 40mg sid for anixietyBeransaIntermittent metacamKeppra for possible seizure on hold as seizure number reducing on own. None 2-3 weeksTreatment: add inCodeiene 30mg for cough at nightHISTORYPresenting for: Jeddah presented for follow-up regarding seizures and ongoing cough.Historical Conditions: History of seizures - frequency has reduced from approximately 5 seizures over recent days (occurring daily to every 2 days) to none observed in the past 2-3 weeks. Previous chest issues and cough that had cleared completely. Bronchomalacia or tracheal collapse with weakening of airway walls noted years ago with audible respiratory sounds when lying down.V/D/C/S: Coughing episodes worsening, particularly at night and when excited (visitors, activity). Cough triggers fainting episodes believed to be due to tracheal blockage and oxygen deprivation. Audible respiratory sounds when lying down present for 1-2 years.Current Meds: Keppra (seizure medication script available but not yet started - client wanted to discuss first), Trilostane 60mg once daily, MetacamLifestyle Risk Factors: Coughing triggered by excitement from visitors and increased activityOther: Client reports stress panting and restlessness at night, difficulty settling due to pain/stress. Temperature regulation issues with head becoming very cold.EXAMMentation: BARBehavioural: Cooperative during examination, accepts treats readilyMusculoskeletal: Some weakness noted, client reports difficulty with back stepNormal pattern respChest clearASSESSMENTSeizure disorder - Significant improvement with frequency reducing from daily/every 2 days to none observed in 2-3 weeks. Underlying chest condition resolution likely contributed to seizure control improvement.Bronchomalacia/tracheal collapse - Chronic condition with worsening cough, particularly nocturnal and excitement-induced. Causing fainting episodes due to airway obstruction and hypoxia.PLANNew Meds/Tx:- Codeine 2 tablets once daily at night initially (antitussive for cough suppression). Can increase to BID if needed. May cause constipation.- Keppra seizure medication available if needed - can be weaned on and off over 2 weeks if required, but currently not starting given seizure improvementAdditional Discussion:- Bronchomalacia/tracheal collapse managed symptomatically only - no curative treatment available given age - Alternative cough suppressants (hydrocodone, Lomatil) available if codeine ineffective- Cerenia mentioned as option though not proven for this indication- Client to monitor seizure frequency and cough response to treatment    Vital Signs    Weight: 41.5;