12405 Venice Blvd #317 Los Angeles, CA 90066 TTO, P significantly improved between Clavamox and butorphanol. A/O CCT for both. Consider changing to oral butorphanol. O has appt with Dr.
Zimmerman at AVCC for cardio consult tomorrow.
12405 Venice Blvd #317 Los Angeles, CA 90066 Other P in household may also be coughing or reverse sneezing. O concerned that other P may have carried an transmitted kennel cough. A/O is a possibility. Consider prescribing antibiotics. O states that Torb has been working better than hydrocodone. P slept more and cough was much weaker. Brief recheck of P revealed continued tracheal sensitivity on palpation, with a dry non-productive cough. Lungs C&E. IV/VI L apical Will treat presumptively for kennel cough, but also rec cardio consult. A/O I believe the cough and the heart murmur are unrelated given that last exam for cough revealed no murmur and had normal heart on CXR, but better to have the consult and determine cause of murmur regardless. Also rec try increasing Torb to 0.06ml SQ q 6-12 hr prn for cough.
Sig: Give 1.2 ml by mouth once every 12 hours for 10 days.
12405 Venice Blvd #317 Los Angeles, CA 90066 TTO, P is coughing and wheezing more often throughout the day now. Hydrocodone still seems to help, but making P feel strange and more difficult to sleep. Discussed using alternative, like butorphanol. O requests something ASAP. A/O only have injecatble on hand, otherwise will take a few days. O comfortable using injectable.
Sig: Inject 0.03 ml under the skin once every 6 to 12 hours as needed to suppress coughing for 7 days.
12405 Venice Blvd #317 Los Angeles, CA 90066 TTO, P continuing to C. O has large quantity of hydrocodone on hand from other past P (deceased). A/O okay to start trial of hydrocodone. Rec use at 1mg PO q 6-12 hr prn for coughing.
12405 Venice Blvd #317 Los Angeles, CA 90066 TTO, P not significantly improved by antibiotics. A/O to finish the course. Since C still localized to upper airway, most likely cause is collapsing trachea. Consider sedatives if C is negatively impacting quality of life.
12405 Venice Blvd #317 Los Angeles, CA 90066 Thx rads: possible mild diffuse interstitial lung pattern, heart normal size and shape, no tracheal collapse noted. Ruleout collapsing trachea, infection.
Rec treat for ITB, and INI then treat for collapsing trachea.
12405 Venice Blvd #317 Los Angeles, CA 90066 Sys: No S/V/D/PU/PD. Good appt and energy MHx: Vestibular episode several months ago, resolved with time and a course of Simplecef (for possible otitis). P has mild coughing bout once every few days historically. Now P doing it a few times per day. C is dry, honking, non-productive.
EENT: AC/lens/conj/cornea cl OU, no erythema or discharge AU, oral - moderate dental calculus, no masses, NSF on palpation of neck H&L: NMA, NSR, SPP, eupneic, crackles ausculted in all lung fields on inspiration only, marked dry non-productive cough elicited on tracheal Coughing r/o infection, inflammation, neoplasia, f.b., cardiogenic, collapsing trachea, other Rec thoracic rads at VCA WLA. O may want to arrange via CA Animal Hospital. A/O not an emergency, so can arrange any time in the next week.
If P worsens at all, then rec get the rads that day.
Discussed HWP, low risk of exposure, but preventative is safe while disease and treatment are dangerous. O to consider.

Source: http://drrosnick.com/site_media/tmp_medrec/74dece041faa23a881aad5c6492c96ab.pdf


EXT. HANCOCK TOWER, CHICAGO - LATE NIGHT Lake Shore Drive. Four o'clock in the morning. Minimal traffic, minimal life. As MAIN TITLES BEGIN, we PAN UP the face of. .Hancock Tower. Up, up, forty floors, sixty, eighty, very dark up here, street sounds fading fast, and as CREDITS CONTINUE we can .a dark FIGURE. Like a spider. Inching its way up the steel surface of the 98th floor, and we CLOS

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