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It's been some time but my little guy Homer is now 14 and…

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Hi Mike. It's me again...
Hi Mike. It's me again. It's been some time but my little guy Homer is now 14 and things are happening. He was diagnosed with a trachea collapse and is taking 2.5 Lomotil; he was also diagnosed with a heart murmur -not receiving and meds at the moment. I think this is unrelated as last night it seemed that his left eye seemed large and both his pupils were dilated. Over the past week he seems to startle easy. His earring seems ok. He barks at everything he sees. So we are confused. His appetite if plied with a treat seems ok. He's pooping, peeing and sleeps more than me.
Submitted: 27 days ago.Category: Pet
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Answered in 1 minute by:
5/27/2018
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Pet
Satisfied Customers: 34,330
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago

Hi Customer...I think Homer is going to outlive me. Please clarify...both pupils are mydriatic (widely open) but the left pupil is particularly so?

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Customer reply replied 27 days ago
but the one on the -sorry right was worse almost seemed a little bigger. Are you in the midst of the volcano
Customer reply replied 27 days ago
Damn and now my 85 year old mom gave him a teaspoon of hamburger meat that had some onion in it ��
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago

No, they wouldn't allow me anywhere near where eruptions are occurring. The first thing I need you to do is stop administering the diphenoxylate because it contains atropine and you might be seeing evidence of atropine overdose (mydriasis). Then I want you to return to our conversation in 48 hours and tell me what Homer's eyes look like. Do your best to keep him quiet because he won't have the Lomotil on board and coughing will be more likely.

Don't worry about the tiny amount of onion. It would take ingesting far more than the meat contained for onion toxicity to be a concern. Please continue our conversation if you wish.

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Customer reply replied 27 days ago
Oh ok I knew I could count on you
Customer reply replied 27 days ago
What is the alternative for the coughing
Customer reply replied 27 days ago
I'd like to stay with you if I may. Thanks
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago

Tracheal collapse is enough of a reason but at Homer's age I also need to consider advanced cardiopulmonary disorders such as congestive heart failure, sterile chronic bronchitis, pneumonias, and neoplasia (cancer) in the chest cavity. Please continue our conversation if you wish.

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Customer reply replied 27 days ago
I guess the next question is what medication is available to him.
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago

We need to know what ails him before knowing which medications can help. Do you know what else other than tracheal collapse was seen in his X-rays? A heart murmur was heard. What did the heart look like in the X-rays? Was his blood pressure assessed? Hypertension can cause retinal hemorrhage and detachment leading to mydriasis.

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Customer reply replied 27 days ago
Is there someway I can send you his discharge notes
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago

Yes, you can scan them into your computer and then give me the link to open or you can photograph the pages and upload the photos by using the paperclip or add file icon in the toolbar above your message box (if you can see those icons on your particular device) or you can use an external app such as dropbox.com/ Please check that the photo(s) is in focus prior to uploading it.

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Customer reply replied 27 days ago
Do u have an email address I send it to
Customer reply replied 27 days ago
I'm not very good at this as I don't do it often sorry
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago

You'll have to contact customer support: ww2.justanswer.com/contact-us or 1-***-***-**** to email something. Support then forwards it to me. Sorry for the nuisance.

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Customer reply replied 27 days ago
No that's fine thank you
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 27 days ago

I'll watch for the files.

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Customer reply replied 25 days ago
DISCHARGE NOTES
199852
Vet: Dr. Dyson
Clinic: NORTHERN VET CLINIC*****
THE PAS MB R9A 1R8
H: Fax:(###) ###-####Bus:(###) ###-####Cell:
Date: 04-Apr-18
Attending Clinician: Dr. Robin MacRae Attending Student: Margot Hayes Diagnosis: suspect tracheal collapse
JOHNSON, DENA/ ED
BOX 3094 THE PAS MB
H(###) ###-####W:
C(###) ###-####ADM: 04-Apr-18
HOMER
TERRIER, YORKSHIRE TRI CASTRATED MALE DOB: 01-Oct-04
heart murmur - suspect secondary to degenerative mitral valve disease
History: Homer, a 14 year old male neutered Yorkshire Terrier, presented to the Veterinary Medical Centre (VMC) Medicine service on April 4th, 2018 for evaluation of a chronic cough. Homer was noticed to start coughing intermittently in October, and the cough was noticed to increase in frequency over the past 3 weeks. The cough is intermittent, and sounds dry, hacking and similar to a goose honk. Homer occasionally has episodes of retching after he coughs. He is noticed to cough more after episodes of excitement, such as running to window, or barking. Homer's coughing episode can usually be stopped by distracting him and calming him down. Homer still has a good appetite and energy levels, and has no exercise intolerance.
Physical Exam Findings: On physical exam, Homer was bright, alert and responsive. He has a body condition score of 7/9, with 5/9 being ideal. His vital parameters (heart rate, respiratory rate and temperature) were all within normal limits. On auscultation of his heart, Homer was noted to have a grade III/VI left sided systolic murmur. His lungs sound clear, with no crackles or wheezes. Homer's peripheral lymph nodes are of normal size and shape. His gums are pink and moist, with a capillary refill time of less than 2 seconds, which indicates adequate hydration and tissue perfusion. Homer does have moderate to severe periodontal disease, and plaque build up on his teeth. Upon palpation of his trachea, Homer elicits a honking cough.
Laboratory/Medical Imaging Findings:
Complete blood cell count (CBC): This looks at red blood cells (which carry oxygen to the tissues), white blood cells (including neutrophils, which help to fight off infection, and lymphocytes, which are also involved in immune responses), and platelets (which help the blood to clot). Homer's results were normal.
Serum Biochemistry: This test evaluates total blood protein levels (to look for signs of dehydration), electrolyte and acid-base levels in the blood, as well as liver, kidney, and pancreatic function. Homer's results show a mild increase in some of his liver enzymes (ALT and GLDH). This might suggest injury or damage to his liver cells, however we have no previous bloodwork for comparison. We recommend monitoring Homer's liver values in order the trend them.
Thoracic Radiographs: This is an imaging tool that is used to assess the heart, lungs and chest for any abnormalities. Homer's results show a mild increase in the size of his left atrium, which can be consistent with mitral valve disease and Homer's heart murmur. There is no evidence of congestive heart failure, and the mild enlargement to his heart is not compressing his trachea. The radiographs also show an area of narrowing within trachea/bronchus. This is consistent with dynamic airway disease. An increase in the size of Homer's liver is also seen, which is a common concurrent finding with tracheal collapse and mitral valve disease.
Summary of Case Management: While in the clinic, Homer had a thorough physical exam and a history taken. He had blood drawn, and underwent a series of thoracic radiographs without sedation. The dental service had a look at Homer's teeth, and then Homer was discharged the same day.
Recommended Treatment/Management:
Based on the results of the tests, Homer's cough is likely associated with a tracheal collapse, although a chronic bronchitis cannot be completely excluded. Further investigations would include performing a fluoroscopy, and possibly a bronchoscopy (scope of the bronchus).
We feel that it is reasonable to start treating Homer with antitussive medications at this point. If the cough does not resolve or becomes worse with the treatment instituted, then consideration can be given to further treatments or diagnostics. The majority of cases are successfully treated symptomatically. Antitussive agents such as lomotil (diphenoxylate-atropine), butorphanol or dihydrocodeinone (hydrocodone) are quite effective in controlling symptoms. Side effects include oversedation, anorexia, and constipation. Occasionally longer use of low-dose steroids could be considered if anti-tussive alone do not control Homer's clinical signs.04-Apr-18
199852***** Saskatoon SK S7N 5B4 Canada Small Animal Clinic:(###) ###-####Facsimile:(###) ###-####4:30 PM
Veterinary Medical Centre, Western College of Veterinary Medicine, University of Saskatchewan
05-Apr-18
Removal of neck collars and utilizing only a harness are
Customer reply replied 25 days ago
Figured out on my own how to get u this info lol
Pet Specialist: Dr. Michael Salkin, Veterinarian replied 25 days ago

Well done! Homer was nicely attended to. Here's what you need to know about tracheal collapse:

Treatment for collapsing trachea is multimodal. It consists of cough suppressants, antiinflammatory medication (a glococorticoid/steroid such as prednisone), bronchodilators, and in severe cases, surgically fluoroscopically, or endoscopically placed stents to decrease the severity and frequency of cough and associated clinical signs.
Acute general treatment involves supplemental oxygen and the judicious use of sedatives and cough suppressants such as acepromazine and butorphanol respectively. Butorphanol is a narcotic antitussive which can lessen acute severe cough and respiratory distress. Acepromazine can provide sedation that breaks the cycle of airway irritation and coughing when a bout of extremely severe, collapsing trachea-related coughing occurs.
Chronic treatment involves weight loss because obesity leads to decreased lung expansion and increased breathing effort; antitussives which help reduce irritation or damage to the tracheal epithelium from chronic cough such as butorphanol, hydrocodone, or diphenoxylate hydrochloride and atropine; antiinflammatory therapy to decrease larygneal or tracheal inflammation - steroids should be tapered and discontinued after 5-7 days of use, however; bronchodilators may benefit dogs with intrathoracic - within the chest cavity - collapse or expiratory effort that doesn't improve with inital therapy - terbutaline, albuterol, and theophylline are bronchodilators to consider; and, finally, surgical stenting in the most severely affected dogs.
Homer's prognosis for survival is good. With appropriate therapy most dogs show improvement but with varying degress of persistent symptoms. The prognosis for cure is poor because collapsing trachea is irreversible and progressive. Please respond with further questions or concerns if you wish.

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