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Meghan, your opinion?

Posted by wantoretire_did (My Page) on
Fri, Oct 13, 06 at 19:41

Our 45 lb. cockapoo (large size) had had a dry cough for at least a year, but has had regular kennel cough vaccinations, and when seen by the vet last year, she didn't seem to think it was anything to worry about. He was boarded at the vet-owned kennel this past April for a couple of nights. Then, we had his teeth cleaned in June and following that, he started throwing up copious amounts of phlegm which has an egg-white consistency, particularly after drinking water/eating. X-rays were taken; esophogus and trachea are clear. Vet said it is a bronchial problem. He was put on an antibiotic, cough suppressent and Terbutaline.

That didn't work, so I sought a second opinion and am much happier with the second vet. He put him on a different antibiotic (Doxycyleine) and a cough suppresent. Said that sometimes a different antibiotic makes a difference, but if that doesn't work we are looking at having to have a bronchoscopy (sp) and cultures, which could run anywhere from $500 to $800, and we may not get any answers even then. I've switched to wet food and have raised his dishes up about a foot, which helps some; at least the food doesn't get stuck and come back up, but he is still throwing up the phlegm at odd times, once or twice a day, with a little food. I've made an appointment for the bronchoscopy for next week.

At my wit's end right now.

Carol


Follow-Up Postings:

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RE: Meghan, your opinion?

I've switched to wet food and have raised his dishes up about a foot, which helps some;
Hi Carol, I'm not Meghane but this sounds like megaesophagus, probably more secondary in nature ( due to something else going on) the link below explains the different medical associations that may be involved.

Here is a link that might be useful: megaesophagus and associated problems


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RE: Meghan, your opinion?

Had the same problem with a an older male lab we had. He had all the same symptoms of your pet. Several visits to vet, kept diagnosing kennel cough, etc. Dispensing antiobiotics. Note - pet never was exposed to any other dogs, when we go on vacation I have a petsitter that comes and stays at the house. Despite telling the vet this and questioning the "kennel cough" dx. This went on for quite a few years. After a vet change, she took a specific x-ray of esophagus and dx was laryngeal paralaysis. It is like a little area where the esophasgus develops a "pool" area which collects the phlegm and causes the coughing and other symptoms. Long story short we ended up at a thoracic specialist and he had to have a very lengthy difficult surgery. Sorry now that I did because by the time we finally got his problem sorted out he was almost 10. He was too old for such a serious surgery. He passed about 6 mos. post-surgery. I have been told this is common to my breed of dog. However, had I known any of this with any dog, I would ask them to take another look rather than accepting the kennel cough dx and the antibiotic (which by the way, did work) he would be fine for a while and then the symptoms would develop again. Its worth asking about. Best of luck to you and your pet.


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RE: Meghan, your opinion?

I want to make sure I understand what your dog is doing, because it makes a big difference in diagnosis and what tests to run.

Dysphagia is having trouble eating. This may cause dropping food because the dog is unable to hold onto it due to muscle/nerve problems in jaws, tongue, mouth, etc. Or he may have trouble getting food into the esophagus which could have a lot of different causes. Once the food gets down into the esophagus, things progress normally, with no reurgitation or vomiting. This is usually an oral cavity problem or a neuro/muscular problem.

Regurgition is almost always undigested food. There is no abdominal effort, no retching. Basically the dog would be just eating or just done eating, and suddenly undigested food or water comes flying out. Often times dogs with regurgitation will try to swallow multiple times. Regurgitation almost always occurs immediately or soon after eating or drinking. It is indicative of an esophageal or oral problem.

Vomiting is different. First the pet gets nauseous, maybe licking his lips, pacing nervously, that kind of thing. Then you'll see retching and abdmoninal effort. Vomiting can occur any time in relation to food/water intake. But it usually has some component of digested or partially digested food, or bile. Vomiting can be related to GI disease or to a non-GI problem that causes nausea.

Expectoration is a respiratory problem. Usually people describe it as "coughing up phlegm" because that is usually what is happening. There isn't any nausea, no retching as in vomiting, but it isn't related to food/water ingestion as with regurgitation.

I'm a little perplexed by your description, because it sounds like a little of everything, which isn't impossible but would be odd.

Cindytx was right on with the thought of megaesophagus especially since elevating the food helped. But that should be obvious on radiographs, at least generalized megaesophagus. Laryngeal paralysis is a good thought too as labmomma said, but that usually has other symtoms such as exercise intolerance and susceptibility to heat stress. Not always though.

Please write back and let me know what you think the "scientific" definition of what your dog is doing- dysphagia, regurgitation, vomiting, or expectoration or any combination thereof. Also a description of the cough may be useful. Laryngeal paralysis usually produces a characteristic goose honk sounding cough, respiratory disease usually more of a hacking sound, dry or wet. Then I may have some more helpful thoughts.


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RE: Meghan, your opinion?

I agree with meghane's description of the laryngeal problem. Only thing is our lab had this problem for years and it didn't really start as honk more like a cough. The honk was nearly at the he was finally diagnosed. Also, no symptoms of lethargy or any other signs of trouble. He never "coughed up" anything more than phlegm. Good luck with the bronchoscopy.


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RE: Meghan, your opinion?

Umm that's weird I wrote a post a while ago and I just came back to check and it isn't there. I will write another shorter version, excuse me if a copy- like one shows up after all.
I just wanted to point out that regular xrays often do not show poor esophagus functions therefore other diagnostic tests such as fluoroscopic, or an endoscopic exam to directly visualize the esophagus may be warrented.Muscle and nerve conduction tests to evaluate neuromuscular function may be indicated as well.
I'm not going to second guess your vets as I don't really know what they tested for that can have these types of symptoms such as myasthenia gravis (a neuromuscular disease), Addisons disease or hypothyroidism (endocrine diseases) just in case I'd run those by them prior to doing any invasive testing. Best of luck


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RE: Meghan, your opinion?

Cindytx, same thing happened to me. Must be something weird with the forum. I had a whole algorithm for working up regurgitation, then decided to see if the dog is truly regurgitating. Sounds like probably. My first thought was an esophageal hypomotility problem with secondary aspiration pneumonia. But the "throwing up phlegm at odd times once or twice a day sometimes with food" thing really threw me off. Technically it would be hard to vomit phlegm, since you vomit from your GI tract and there isn't phlegm there, unless you swallow a bunch for some reason. But food comes from the GI, and he's throwing up some of that too, plus the first descrition that really sounded like regurgitation (and just after a dentistry- wouldn't that be perfect- esophageal irritation/inflammation causing regurg, but the cough started before that) ... I just can't tell from the description what the dog is doing.

I hope carol writes back soon.


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RE: Meghan, your opinion?

I hear ya Meghane. It's very hard to give opinions whenever you're not actually seeing things for yourself. It's hard on the posters too trying to explain. Lost in translation stuff.
Plus there is the difference stages of disease processes which sometimes gets confused within the different symptoms, add the primary and secondary reasons and things really get confusing! LOL
I do feel for the poster though, this "behavior" has many faces and unfortunetly any avenue chosen whether the less invasive first or vise versa I think she's in for a battery of testing. Keeping fingers crossed they find the problem and there is an easy fix.


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RE: Meghan, your opinion?

Golly, thank you all for responding. Meghane, it definitely is not vomiting. It is just the phlegm. If there is a little food with it, it is immediately after eating. Otherwise, it is pretty clear and foamy,and usually once or twice a day. Some of it will hang from his mouth (like Hooch). I've raised his dishes about a foot, and give AM and PM meds with a chunk of hot dog about 1/2 hour prior to feeding and no water, and they stay down. I've been feeding 4 small meals so he doesn't wolf down a lot of food at one time.

He is ready and willing to run and play, but I've read that its best not to be too active right now, so we don't encourage it.

Carol


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RE: Meghan, your opinion?

How old is your dog?


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RE: Meghan, your opinion?

Ooops - He's 8 1/2 yrs.


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RE: Meghan, your opinion?

So when he brings stuff up, it is ONLY when he's coughing? Or is there regurgitation too? I'm still a bit confused. Of course, I'm also supposed to be studying for an equine medicine exam, so confusion may be a temporary state of existence at this point. I'd rather be doing this than studying though.


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RE: Meghan, your opinion?

I'm confused too, but now I am wondering if this may all be allergy related.


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RE: Meghan, your opinion?

Meghane - The best I can describe is Expectoration, sometimes apparently triggered by eating or drinking. Other times, just random. Water does not fly out; it is just phlegm.

Carol


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RE: Meghan, your opinion?

I think that your second vet sounds like he is doing the right thing, switching meds, trying something else and then proceeding with more testing...

If the new meds and cough suppressants aren't working then - (they can pretty much rule out kennel cough) And you are doing the right thing by proceeding with the brochoscope...

Good luck and let us know what happens.


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RE: Meghan, your opinion?

Cody's bronchoscopy was done today. No paralysis, and the tentative diagnosis is bronchitis, or could be asthma or COPD; treating for bronchitis for now. We should get the results of the cultures by Tuesday. I watched most of the procedure on the monitor. Anatomically he's fine. He's home and sleeping now and on yet another antibiotic and cough suppressent. He can have water at 7:00 and some food at 10:00.

Will keep you posted on the results. Thank you again for all of your concern.

Carol


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RE: Meghan, your opinion?

Glad to hear he's doing well and that he looks OK. Hopefully he's just had an infection that can be cured easily.


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RE: Meghan, your opinion?

That doesn't suprise me after your last post which is why I said possible allergy related. However something completely slipped my mind and that is there are some bronchial problems that cocker spaniels seem to have a high incidence of, here's a little info below.

.Bronchial prolems have frequently been observed in young to middle-aged cocker spaniels.

Coughing is the hallmark of bronchial irritation. The cough usually is dry but posttussive gagging and bringing up phlegm. (owners may misinterpret this as "vomiting").
RISK FACTORS
Recurrent bacterial infections
Long-term exposure to inhaled irritants or allergies
Obesity
Dental disease and laryngeal disease (bacterial showering of airways)

other airway problems are,Chronic obstructive pulmonary/lung disease (COPD/COLD), bronchiolitis, small airway disease some other health issues that may have similar symptoms or be related are
Cough
Hypoxia
. Asthama
Tracheobronchitis, Infectious
Bronchiectasis--Dogs

anyway your new vet seems to be right on on knowing what to test for.


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RE: Meghan, your opinion?

The final diagnosis is asthma. Cody is on dimishing doses of prednisone, and continuing with aminophylcine (sp) and Tribrissen. Minimal throwing up of phlegm. I've been feeding him in two "courses" to minimize the coughing/routing like a pig, etc. He's doing much better.

Carol


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RE: Meghan, your opinion?

Hi Carol, I was hoping I would see you post soon, I was wondering how you made out with Cody.
Glad to hear you got a diagnosis and hope the treatment works. Best of luck!


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RE: Meghan, your opinion?

I'm sorry to say that there hasn't been any improvement in Cody's condition; still dealing with the same problem and it seems to have increased the past few weeks. At the beginning of treatment I thought that this is just a part of the diagnosed asthma, not being familiar with that. We are going to see the vet and bronchial vet tomorrow.

I am again at my wits end. Drinking water definitely is a trigger and if it follows eating, then that comes up in addition to the phlegm. He's not eaten much or kept what he did, down for the past few days, so is losing a little weight again. Still in good spirits but activity has slowed this week.

I have heard that this type of ailment is becoming more common. Have there been any new discoveries in the last 6 months?

Carol


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RE: Meghan, your opinion?

I just had an inquiry about Cody's condition and realized that I never came back to post.

The only thing that has brought that the phlegm business to an end is 5mg of prednisone a day forever. You have to go into the regemine from the beginning - larger dose, then tapering off to the 5 mg. per day (1 tab.). If
there is to be any surgery, you MUST discontinue the prednisone, as the dog will not heal while taking it, then reintroduce it following complete healing. THAT is a whole other story in itself :-(

I hate having to give him the pred, but the constant phlegm, after EVERY drink of water, was more than I could handle. He was also losing weight in the process. He's now gained some back and is his old happy self, I'm glad to say.


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RE: Meghan, your opinion?

Researching my dogs new problem - throwing up phlegm after drinking water.
Just started about two days ago, thought he was drinking too fast but now not so sure. My dog is almost 3 years old and he is a red nosed pit bull. Generally in excellent health but the past couple days he has been sleeping a lot. Any advice??


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