Choking/ vomiting boxer dog- ideas??

Re: Choking/ vomiting boxer dog- ideas??

Julie Innes — Fri, 14 Sep 2012 23:45:28 GMT

Thanks, James- I'm always grateful for something up my sleeve ( although that sounds a bit weird, doesn't it? You know what I mean!) I'm not counting any chickens yet with this guy- he has initially "improved" on so many treatments that I'm nervously sceptical!

Re: Choking/ vomiting boxer dog- ideas??

James Laidlaw — Fri, 14 Sep 2012 23:41:04 GMT

We have a case at present with a similar problem, now not so controlled on pheno. Tried ceremia, but can only do 5 days on then 2 days off, then suggested to try hyoscine patches, not great response. Next step is hyoscine tablets, but much lower dose than buscopan - small dog will be on 1/3 of a 150 microgram tablet bid/tid. If that doesn't work can apparently use gabapentin, or Botox into the salivary gland (which sounds quite expensive and short lived apparently). Just so you have some other options up your sleeve if things go backwards! Hope he's doing well now though!

Re: Choking/ vomiting boxer dog- ideas??

Julie Innes — Fri, 14 Sep 2012 23:15:22 GMT

Hi all- update as requested! Having finally decided to give the dog the phenobarb, his owner reports he is doing much better- still the occasional episode but far far less frequent, so huge thanks for those who suggested it!

I'm trying to get him back in to see me, though, as they mentioned other slight anomalies, and I'm still concerned the dog may have some other more sinister neurological issue (esp given it's a boxer!), but his symptoms are being reasonably controlled now, so wanted to say a big thanks to Judith and others who suggested the phenobarb!

Re: Choking/ vomiting boxer dog- ideas??

Alice Courtney — Wed, 29 Aug 2012 08:54:47 GMT

Thanks for the update on the case. Sounds frustrating! Still, you're doing everything you can and at least the owners are communicating with you, albeit a week after they have concerns! Good luck with it!

Re: Choking/ vomiting boxer dog- ideas??

Utlendigur — Tue, 28 Aug 2012 23:23:42 GMT

We had a case in very recently of a 8-9yr old female boxer with sudden onset (ie started during the middle of the night - dog was apparently normal the previous day) pacing and salivating++++. Initially thought due to nausea but no response to cerenia etc. Then started to become more neurological over course of the morning so was referred that day. MRI showed multiple abnormal areas in the brain, so then had chest/abdo xrays and ultrasound and turned out to have a heart base tumour on ultrasound (brachycephalic older dogs are at increased risk). Probably irrelevant but it just seemed to have some parallels (breed, age, drooling) - may be worth ultrasound of the heart? Still not sure why it had such an acute onset in our boxer unless maybe thromboembolic disease triggered the neuro signs.

Re: Choking/ vomiting boxer dog- ideas??

Julie Innes — Tue, 28 Aug 2012 21:52:53 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Julie Innes"]. Sigh. They want to know what I think.[/quote]

P'raps you should tell 'em............... are they easily offended?

[/quote]

they are actually really nice, just not very good at following instructions! Even if they would call me and explain their concerns/ reasoning, I could maybe reassure them, it's just maddening when I phone to find out how the dog is to find they haven't given it any of the tablets, for spurious reasons!

I'm actually starting to worry that this guy might have a brain lesion, given the deterioration they mention. In which case I'm worried they'll give it the tablets, it will get worse anyway, and it will be "because of the tablets" (ie my fault!) So I have tentatively mentioned the possibility of something more sinister (it IS a boxer, after all) but would still like them to try the phenobarb! I'll let you know how it goes

Re: Choking/ vomiting boxer dog- ideas??

Evelyn Barbour-Hill — Tue, 28 Aug 2012 21:28:08 GMT

[quote user="Julie Innes"]. Sigh. They want to know what I think.[/quote]

P'raps you should tell 'em............... are they easily offended?

Re: Choking/ vomiting boxer dog- ideas??

Joyce Whitehead — Tue, 28 Aug 2012 21:22:12 GMT

Eek, how maddening. Sadly they sound like the sort of owners who will give one dose and then decide that he is rather sleepy....

Re: Choking/ vomiting boxer dog- ideas??

Julie Innes — Tue, 28 Aug 2012 21:14:11 GMT

After my last post., I contacted the owners and explained the potential theory. They initially said the dog was "better" on the zantac (of which I was sceptical. I'd also given it metoclopramide, but they didn't give it them as they thought it was a bit sleepy after the first one. Sigh) They weren't keen to try the phenobarb as I couldn't "do a test" to confirm the potential diagnosis, but I persuaded them to think about it.

Couple of days later, surprise surprise, the dog was choking/ vomiting again, and now they were keen to try the phenobarb. I made it up for them, explained that the dog may initially seem a bit dopey while it adjusted to the medication, but not to worry about it. They were to call me in a week, and I gave them a week's worth of medication. Meant to phone them end of last week, but got crazy busy. Owner phones this morning to say the dog is worse- now staring into space and ataxic, as well as the choking / vomiting. Oh, and THEY DIDN'T GIVE IT ANY OF THE PHENOBARB, because they thought it might "put it off its food" and he was doing a bit better again. . Sigh. They want to know what I think. I think they should give the drugs I did all the research for and prescribed for them a try!!!! So, apparently they are going to start them today, and will let me know! But I'm not holding my breath....they seem quite capable of giving one, then deciding they don't work/ changing the dosage to something they have made up/ god knows. We shall see.....

Re: Choking/ vomiting boxer dog- ideas??

a.bardell — Tue, 28 Aug 2012 18:01:00 GMT

I second the phenobarb. had a dog at my last practice, another boxer that presented with excessive salivation to the extent that by morning the kitchen was nearly flooded.

intensive work up revealed nothing so after consulting referral practice tried on phenobarb with impressive results. as far as i know has never looked back.

Re: Choking/ vomiting boxer dog- ideas??

Alice Courtney — Tue, 28 Aug 2012 13:57:06 GMT

Did you try Phenobarb in the end with this case? If so what was the response?

Re: Choking/ vomiting boxer dog- ideas??

Julie Innes — Sat, 11 Aug 2012 00:34:55 GMT

Don't think so, Sarah. I had a good look at his throat when he was sedated, and both arytenoids definitely moved equally when the larynx was stimulated. Also he has no stridor, fine at exercise. It's the vomiting/ choking, which often happens when he is in his bed.

Don't you just love these cases!

Re: Choking/ vomiting boxer dog- ideas??

Sarah Keir — Fri, 10 Aug 2012 21:47:07 GMT

Laryngeal paralysis?

Re: Choking/ vomiting boxer dog- ideas??

Julie Innes — Fri, 10 Aug 2012 18:48:18 GMT

Wow, that is really interesting, and does sound a lot like my boxer! Thanks so much- I'm seeing him on Monday so will discuss this with the owner and possibly trial him with phenobarb. I'll let you know how he does- thanks again!

Re: Choking/ vomiting boxer dog- ideas??

Joyce Whitehead — Fri, 10 Aug 2012 14:40:02 GMT

No I don't think so Julie - he was a manic little dog (still is) but got rather depressed after a couple of weeks of this horrid vomiting/regurgitation thing. For the owner, the thing that nearly tipped her into PTS was him vomiting into her slipper shortly before she put her bare feet into them....

Ian suggested we could try to wean him off, but as I said upthread he deteriorated when we did that. Here are the journal references Ian sent me at the time. It worried me a bit that Eric wasn't a pup, but around 4years old (RSPCA rehome so age not certain). At least a trial of phenobarb is cheap!

Incidentally there was no evidence in Eric of enlarged or painful salivary glands, as these cases seemed to demonstrate that.

Hope you get somewhere.

Phenobarbital-responsive ptyalism, dysphagia, and apparent esophageal spasm in a German shepherd puppy.

Gibbon KJ, Trepanier LA, Delaney FA.

Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706-1102, USA.

Abstract

A 10-week-old, male German shepherd dog was presented with a primary complaint of episodic ptyalism, dysphagia, vomiting, and mandibular salivary gland enlargement. An esophagram with fluoroscopy showed normal pharyngeal and esophageal function; however, upper gastrointestinal endoscopy and cervical ultrasonography revealed a focal circumferential thickening of the midcervical esophageal muscular wall, consistent with esophageal spasm. The puppy responded dramatically and completely to phenobarbital treatment. An unusual syndrome of phenobarbital-responsive hypersialosis was consistent with this dog's clinical presentation and the finding of apparent esophageal spasm. The pathogenesis of this syndrome is unclear, but it may represent a form of limbic epilepsy or peripheral autonomic dysfunction.

J Small Anim Pract. 2000 Sep;41(9):416-21.

Idiopathic phenobarbital-responsive hypersialosis in the dog: an unusual form of limbic epilepsy?

Stonehewer J, Mackin AJ, Tasker S, Simpson JW, Mayhew IG.

Department of Veterinary Clinical Science and Animal Husbandry, Small Animal Hospital, University of Liverpool, Merseyside.

Abstract

Three unusual cases of salivary gland enlargement and hypersialosis in the dog that responded to anticonvulsant therapy are reported. Presenting complaints included weight loss, hypersalivation, retching and vomiting of several weeks' duration. Two dogs were presented with enlarged painful mandibular salivary glands. The third dog exhibited bizarre behaviour (including jaw chattering) and developed enlarged painful mandibular salivary glands during hospitalisation. Fine needle aspirate cytology and biopsies from the enlarged salivary glands revealed no significant pathological changes. In one dog, an electroencephalogram revealed changes consistent with epilepsy. Hypersialism and salivary gland enlargement resolved completely during phenobarbital administration in all cases. Two dogs were successfully weaned off treatment six months after diagnosis. The remaining dog relapsed after eight months, but normalised with the addition of oral potassium bromide. It is hypothesised that the syndrome idiopathic hypersialosis may in fact be an unusual form of limbic epilepsy.

Re: Choking/ vomiting boxer dog- ideas??

Julie Innes — Thu, 09 Aug 2012 23:57:40 GMT

Thanks, Joyce! It's an angle I hadn't looked at, but really interesting! This guy isn't insured either, and I'm not sure how far his owners want to take it. Being a boxer, weird limbal epilepsy is certainly worth a look- funnily enough the owner was telling me tonight about some weird jerky thing he does with one of his legs (although I wasn't really paying it much attention at the time ) Did your patterdale have any other odd signs?

Re: Choking/ vomiting boxer dog- ideas??

Joyce Whitehead — Thu, 09 Aug 2012 20:50:25 GMT

Hi Julie

Might not be anything remotely similar, but I had a case a year or two ago in a small patterdale cross terrier. He would also appear to produce too much saliva, and nothing worked at all. Finally after some expert advice from Ian Battersby (of this forum too), by email, he suggested trying phenobarb as some odd limbal epilepsies will present like this.

Eric the terrier was not insured so referral was not an option. PTS was the next step if he hadn't responded, but I'm pleased to say he improved within 48 hours and has never looked back. Still on phenobarb as reduction causes a recurrence of signs.

Hope that helps, I know how frustrated you must be feeling!