C09997984 / invoice 10000

from catheryn walshHi Lisa,I agree with the echo report - the cardiac silhouette is not remodelled enough to blame the coughing on the heart. So we are looking at a primary respiratory issue for the coughing. There is a moderate bronchial pattern. There is nothing else to note.Differentials for the coughing include:chronic bronchitis,heartworm disease (not suggestive from the radiographs, but worth a simple in-house test to rule out),dynamic airway diseasebronchopneumonialungworm infectionotherCathRelayed to Anne-Marie.Plan: Rec HWT testCourse fenbendazole to r/o lungworm 50mg/kg orally for 3ddStart pred 1mg/kg PO bid 7dd then 0.5mg/kg bid 7dd - hopefully should be seeing an improvement by then. Start eod and taper to LED. (Maintenance dose ranges from 0.1-0.25 mg/kg PO q 12-72 hrs).  After 2-4 months on a stable maintenance dose, try gradual discontinuation. May may relapse and require reinstitution of pred. Consider inhaled steroids (fluticasone propionate at 110-220 µg per dog IN q 12 hrs    Vital Signs