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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 41880
Experience:  University of California at Davis graduate veterinarian with 47 years of experience.
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If possible, for Dr Salkin, who has been aware of this case

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If possible, for Dr Salkin, who has been aware of this case previously (but for others, my 15 year old jack russell has melanoma and had it removed from a lymph node and the cheek, with a clean 1mm margin, in June of this year)Hi Dr Salkin.....wondering if you could just help me think this through.....I'm waiting for a call from radiotherapist (the one who's miles away) and as yet no call. I'm not complaining, I've messed them about, all be it not intentionally. But while I'm waiting for the call I'm worried about Toby, I will chase it up tomorrow...........I've emailed the specialists that are closer and they just said yes tumours can restrict airways and swallowing and the best thing for Toby is radiation (they are not saying they would think he has more tumours, just answering my question that yes, they can affect breathing and swallowing)...........so that hasn't really helped. They would be happy to see him but maintain they think he should be travelling to the radiation centre instead. My local vet has said that if Toby's breathing rate is normal, he's not coughing constantly.........as in what we've talked about here, not persistent dyspnea, then there is no blockage of the airway....................But I need to think through the next steps. 1) I will discuss with the oncologist / radiologist, hopefully tomorrow; 2) I need to consider just having Toby assessed locally, I'm just worried about something like an infection being missed. I'm thinking an x-ray and temperature check and any other assessment for infection might be important........................In the last 2 days he's been sleeping really deeply. He's still enjoying walks, although at the end of his park walk today he coughed and yesterday at the end of a 20 min walk he was having reverse sneezes. Today when I stroked him his left ear seemed really hot, like he'd pressed it against a heater (he hadn't). After 5 mins it felt normal again and my mother said it was where the ear was pressed against the pillow. But it did seem much too hot for that to me (but shortlived). If anything Toby seems happy enough, just 'lazy,' sitting around, sleeping deeply, going on walks but not insisting on going very far, etc...........so it's all a bit ambiguous, but the symptoms are not going away and if anything he seems less lively and more likely to get coughing and reverse sneezing today. He's had his chest listened to twice in the last two weeks and been told its clear, so would that rule out things like kennel cough or other infection? I have another appointment with my local vet on thursday. My gut feeling is that he has an infection and is not fighting it off by himself, so I'm worried about leaving him overnight even, but he lives with my mother and she said he's fine when he's just sat at home or going out in the garden (and he looked ok sat next to her on the couch this evening). I know it could be spread of melanoma, but I'm just concerned that whatever it is he's kept comfortable (and treated if its right for him and not too stressful.....I may still attempt the journey for radiation once more but Toby's not behaving 'strong' at the moment for such a trip). Thanks for listening.
Customer: replied 9 days ago.
https://we.tl/t-EYFaPaw0BB I don't know if the link will work. Should be a video of Toby today. If you can delete after viewing that would be good.

Dr. Michael Salkin is typing. Please be patient.

Sorry for the delay. Moving into a new home...

1. Yes, the oncologist/radiologist should be your go-to vets at this time.

2. You can take Toby's rectal temperature. Normal is 38-39.2C. An X-ray would be taken prior to initiating radiation therapy. Whether you have that done now or then is your choice.

3. We can't ignore that Toby's cancer is worsening without therapy. No, auscultation, alone, can't rule in or out anything. X-rays are needed. Infection is not a given.

4. Video: a quiet, sleepy or depressed dog; the cough can't differentiate between lower (lung/trachea) or upper respiratory (trachea, oro- and nasopharynx disorders.

I don't see an increased respiratory rate.

Dr. Michael Salkin and 3 other Dog Specialists are ready to help you
Customer: replied 8 days ago.
Thanks Dr Salkin. Just for your info, the oncologist has called and has said that my concern about the airway being blocked is not a typical concern for them, typically this will go to the lungs. Also Toby has had a diseased lymph removed, which makes it less likely and he also feels the vaccine may be influencing things and be building in strength, so we are not in a situation where Toby's been completely untreated. So I will consider whether we will attempt the journey once more.......Meanwhile now wondering whether I should pester the local vet today just to assess for infection, or whether waiting until our appointment tomorrow should be ok. Mum reports that he was wagging his tail this morning when greeting her, he does seem a bit subdued, like in the video, but still eating, still up for a walk and a check of the garden, etc.......just no bounce, lol. (re resperation rate, I've been checking a lot and it's never raised). Thanks
Customer: replied 8 days ago.
Hope you like your new home Dr Salkin, by the way!

Please wait until tomorrow. The local vet would prefer that you did you. Yes, I hadn't forgotten about the vaccine but am circumspect about how long it can remain effective.

Customer: replied 8 days ago.
We saw the local vet today, I didn't see your message or I might have thought twice, there was no real intention to pester (I joked about that because I tend to do it, I lost my dad suddenly and always worried that I won't act fast enough on something). I'm concerned that we don't miss anything more common, other than the melanoma, like infection. The vet listened to his heart and said that it sounded healthy and that if he had an infection or anemia then heart rate would be raised. So I was reassured for the moment and decided not to have him taken out back for bloodwork or temperature check and the vet said they too felt it was ok to monitor him. But I'm aware this started 2 weeks ago with reverse sneezes and today there was a bit of coughing. When I picked him up he felt heavy, the way he's felt in the past if a bit unwell. He's happy, but something is amiss. I guess I should really have pushed for more tests? We may not be able to do anything about the cancer, but just thinking it might be some other condition or virus, or foreign body...................by the way, your account above did help me sort my thinking out and I was emailing the Oncologist this morning after thinking it all through, strangely enough he called at the same time. That's what happens when we get clarity over something, lol. Thanks.

You're welcome. If his vet didn't recommend more testing, testing wasn't expected to be informative.

Customer: replied 8 days ago.
things like kennel cough, pneumonia, etc, generally are not considered to be present? So does this mean this could either be a much milder infection or melanoma spread? In which case I watch for a few more days...it's just that this is a new symptom and been present in some form or other for two weeks. Can that happen for reasons other than cancer in dogs?

Infection need not be a consideration at all. By the principle of Occam's Razor, metastases should on the top of our differential diagnosis list. My next diagnostic of choice are chest X-rays,

keeping in mind that lesions under 2 mm in size aren't apparent in the lungfields.

Customer: replied 8 days ago.
Thanks, ***** ***** I agree, its just because of wanting to be as minimally invasive as possible, I wondered about ruling out something more simple......as x-ray means being admitted again for the day and he's had enough of that.......but maybe it would be necessary to know what to do for palliative care if nothing else....

You can request that X-rays be taken. I can't imagine his general vet not acquiescing to your desires.

Customer: replied 8 days ago.
I may do, I just wonder if knowing whether it's metastases is helpful in that there's little that can be done, also it would require Toby to be admitted for the day for the x-ray. That's a bad day and one he can't get back....so I think the only way I'd do that is if it offered treatment options afterwards. With melanoma there's not much but maybe it can offer pain relief etc.

I understand.

Customer: replied 7 days ago.
Dr Salkin, I am going to visit him today and will see how he is. Are you suggesting x-ray to avert a catastrophe like an airway blockage? Or for some other reason that I'm not aware of? I'm inclined to watch for today and tomorrow if he's otherwise ok and no worse (and quality of life is not too bad, which its still ok at the moment, this isn't happening all the time)....but you've been with me from the start on this and I'm listening. It won't be too terrible a day for him if it's done at the local vet. I feel helpless doing nothing and if it's metastases then he could have pain relief if necessary.
Customer: replied 7 days ago.
You mentioned being on Hawaii time now, hope my messages don't disturb at the wrong time. I will message on your time if so.

X-rays will tell you if any further care makes sense.

Customer: replied 7 days ago.
Thanks Dr Salkin. I called the specialists nearby and they are consulting with my local vet. Toby is slightly better today, Barking at hedgehogs...the vet's will call later and may try antibiotics to start as he has a slight nasal discharge and follow with x-ray if no improvement or any worsening. I called them thanks to your message. Want to stop guessing game and worry.

Well done!

Customer: replied 6 days ago.
No need reply Dr Salkin. Toby is 80% better today. Brighter eyes, mischievous and scheming, 2 good walks. Still coughing but more lively. I know cancer can show symptomatic improvement, especially as his antibiotic has 'immunomodulatory' effects....but have a little bit of hope that he can enjoy walks again for a while. Thanks again....was very complex to think through.

Thank you for the good update.

Customer: replied 2 day ago.
Dr Salkin.....I'd value your reflections on this.............Toby improved almost 100% on the antibiotics which he finished today. He took me for a walk yesterday and today. His reverse sneezing and cough had almost gone in the last two days..........apart from a bit of reverse sneezing when he chased something in the bushes at the house today. But even then, he know longer sounds 'hoarse' like he did. Everything has improved.......and I'm grateful for that because I thought his walks were over, instead they've stepped up again........he lives for the walks.......But that all said, I feel his swallowing is still a bit prominent. I think it always was all his life, but probably a bit more so. Are there ways a vet can check that the airway is clear from examination? I don't suppose there is. So I guess I have to decide whether to have him x-rayed at the local vets, or CT'd at the local specialists. As he doesn't want anymore treatment and I think he'd give up if he had to be admitted again......I wonder whether to just have an x-ray and wonder if you know how quickly they can do this sort of thing? I wouldn't imagine he'd be under anaesthetic for long (if you have a minute, his swallowing can be seen on this video)....https://wetransfer.com/downloads/f6bd110cc8cba562dc3*****************0916152209/d836b6

I saw the gulping. Twilight sleep can be provided for a vet to directly visualize Toby's oropharynx. It then can be reversed with another drug. X-rays are reserved for negative findings in direct visualization.

Customer: replied 1 day ago.
Thanks Dr Salkin
Customer: replied 1 day ago.
Dr Salkin may I ask. If a dog can walk around and run up stairs without any difficulty, is he unlikely to have an airway blockage? Tobys on a walk with me doing just that....but we are walking near the vet's because we can'talk get an appointment for another couple of hours. I wanted to get him x-rayed as he was a bit distressed this morning by reverse sneezing and then a couple of gulps. His tail is half mast. ...so walking near vets as I can only go in there if emergency. When do I know it's an emergency? Apart from the obvious and a dog is dying. If you think i'my being over anxious I don't mind if you say. I tend to be since seeing my father die. Rational brain is saying if he can walk about he's safe.....but maybe don'the feed him until his appointment as they may want to do an x-ray. My concern is that they'll say it's too late in the day to do it.....and that they can't do it until tomorrow. And they can't check because he's too anxious to let them......sorry for this ramble. Thanks.

It's still possible, yes, if the blockage doesn't prevent adequate oxygenation. Pale gums and tongue indicate anemia and anemic animals don't have enough red blood cells to oxygenate themselves. Bluish/greyish gums and tongue indicate cyanosis - a lack of oxygen to the tissues.

Customer: replied 23 hours ago.
Thanks Dr Salkin. Apologies for the typos. Its predictive text on my phone. Toby's gums are pink. I've taken that on board. My mother reports that he ate without problems while I was out.....but she's hard of hearing and doesn't hear the gulping. He seemed more distressed earlier with reverse sneezing. If anything it sounded a bit congested and he wanted to get out in the garden to eat grass. I took him out shortly after for a walk near the vet's when I messaged you. He was ok walking. Interested in things etc. But he's not as happy as usual. The local specialists can't call till tomorrow now. The local vet can get him in for x-ray next Monday. I always thought if there's a problem with the throat it's a potential emergency. Anyway I'll remain on tenterhooks until I've spoken to the specialist tomorrow. I appreciate all your help.

YW!