C10026095 / invoice 10000

Appointment Notes: another uti and lump bleeding-tl few minutes lateHistory: Doing ok. Been in season  following up re cystitis. No blood in urine  also has lump midline ventral abdomen. Examine: H/l ok. Mm ok. Teeth ok. Ears eyes ok. Abdo palp nad. Bladder on painful empty. Vulva swollen no discharge. Pedunculated lump ventral midline over umbilicus. Has erosive lesion from rubbing.  Disc desexing lumpectomy and prophylactic gastropexy. Laboratory: Urinalysis- voided. Usg>1.050. Urostix- pH-6. All else wnl. Sediment unremarkable. Differential Diagnosis: In season Treatment: Plan:Q- for desexing and lumpectomy- 1200 no histo. We cannot do pexy. Lump may be hernia so careful dissection needed.    Vital Signs    Weight: 59.5;