I have a cousin whose 10 year old dog has had this for six months. They chose not to have surgery because they didn't feel it would improve his life and at age 10 they considered it too much risk.
I did copy Dr. Doug's remark about the Doxepin this morning and sent it to her. She was glad to hear it recommended somewhere else. She said they started the treatment with Doxepin just last week and Wrigs is remarkably improved! She is hopeful it means his life will return to normal now. Just thought I would pass this on. Like so many, I had never heard of it till I saw my cousin last week for a family dinner. Her husband did not join us because they don't leave Wrigs alone. If he gets excited and tries to bark, he starts with asthma type symptoms, so one of them stays with him all the time to keep him calm.
Glad to hear Jake is doing better and now you know there is another treatment besides surgery you may be able to try if needed.
Dale