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Dr. Joey
Dr. Joey, Board Certified
Category: Dog Veterinary
Satisfied Customers: 3776
Experience:  15 yrs in practice, specialist canine/feline medicine
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My 6 yr. old, female yellow Labrador retriever who is otherwise

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My 6 yr. old, female yellow Labrador retriever who is otherwise healthy & happy, not overweight (70lb) started vomiting 2-3 weeks ago. These vomit sessions were full diaphragm, contents emptying vomits. Initially started after a short (1/4-1/2 mile) walk just following 7am Beneficial dry food breakfast. Just prior to vomiting, upon last few hundred yards of walk, very heavy panting and frothy, very slimy drool would form around her mouth and drip/drape from her gums & lips. Normally she does not drool. Prior to entering the house, I'd wipe free any of the drool. Within 30-40 minutes following the walk, she emptied the contents of her stomach. This vomiting pattern would slowly, but steadily increase over the following days to 3-4 times a day. After the food was completely evacuated from her stomach from the first couple vomits, bile only or a bile & phlegm mix would produce. Additionally, I noticed her stool becoming increasingly soft and more yellow in color and her energy level dropped dramatically. All awhile her appetite never ceased. Because of this vomiting and severe decrease in her energy level, I took her to the family vet, where her potassium was checked and was within limits...Addison's disease was suspected. Her resting heart rate at the Vet's office, while panting quite rapidly, was 42, 48 & 38BPM. A "heart block" was suspected, so I took her immediately to the cardiologist where EKG, ECG, Ultrasound of the hearts valves & major arteries and an ultrasound of her stomach and intestinal track. She has some mild regurgitation was noted in Mitral Valve, Tricuspid Valve, Pulmonic Valve & Left Ventricle systolic function is mildly reduced. Initial conclusion: 3rd Degree Heart Block. Immediately took her to University of Florida where a pacemaker be installed on 10/17/13 with no remarkable complications. Medications are Cephalexin(500&250mg) every 12 hours, Sucralfate(1g) every 8 hours, Pepcid(10mg) every 12 hours. Brought her back home(Naples, FL) at 6pm on 10/18/13 where her overall demeanor and alertness was good and strong. By 10/18/13 at 9pm and after the anti-nausea medication, which was given to her in surgery, finally wore off, esophagus regurgitation started. The regurgitation is just that…no food or bile present and regurge and occurred 2 times on 10/18. 10/19 regurge occurred roughly 10 times, 10/20 regurge occurred 20-25 times and the following and very troubling started. She had been resting quite a bit following surgery and when I took her outside to potty, she had some difficulty rising from the floor. She walked outside as if the pads of her paws were either burnt or raw…more of a hobble really. Just following her squat to urinate, she went to stand up, got very wobbly and then her front legs gave out. 2nd attempt was no better and was even more of a face-plant into the grass. At this point she lay there, knowing something was up. She does not appear to be in distress, doesn’t appear to be uncomfortable and is still very alert and happy acting…she just has major issues going on with her muscles. This happened again in the evening and even worse the following morning. Yesterday, spent several hours with the cardiologist and Internal Medicine doctor, ran another set of EKG, ECG & X-rays and everything with the pacemaker and heart is intact and functioning well, respectively. Waiting on results of: Thyroid Panel, Acetylcholine Receptor Antibody, and ACTH Stimulation test as well as a full blood panel. Blood panel is OK. She continues to regurgitate and is this morning at the point where I have to carry her in and out to go potty as her legs just give out after 3-5 seconds. Idiopathic is where we are until the test results come in…Thank you.
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Joey replied 1 year ago.

Dr. Joey :

Hello I am Dr. Joey. Thanks for trusting me to help you and your pet today. I am a licensed veterinarian with over 15 years of experience. I look forward to working with you.

Customer:

Thanks. I am running out NOW, but will be back online in about 75 minutes. Thanks

Dr. Joey :

This has been quite an ordeal for you and Bingo. My first thought is to rule out myasthenia gravis, which you are doing with the acetylcholine receptor Ab test. Our other top differential diagnoses have been ruled out (heart arrhythmia, hypoglycemia and Addison's disease). Other possible causes might be a new electrolyte disorder (involving calcium or magnesium), toxin exposure, or a Neurocardiogenic bradycardia-related syncope (unlikely).

Dr. Joey :

Will wait for you to return to continue our chat. I need to know what questions you have!

Customer:

I am back Dr. Joey. I guess what I would like to know is what you have partially answered thus far...what do you feel could be some of the causes for this.

Customer:

I am anxious for the results of the tests. The only other thing that my wife and I thought it could have been was Boric Acid poisoning. The vets...all of them, seem to think not. I questioned whether it could have been only because of the timing of things. I sprinkled the boric acid in my garage, around the bottom of the shelves, the inside perimeter of the garage walls and under my AVT trailer. My three young children think its funny to throw Bingo's food under the trailer so she has to crawl around and scarf it up. There was a decent amount of boric acid that I am certain she ingested. The signs and symptoms she demonstrated, leading up to the heart block diagnosis, were consistent with this type of poisoning. That is the only environmental change that we could possibly think of and now she has been away from that area of the garage, which has also been all cleaned up, for several days now, and things continue to evolve and deteriorate.

Customer:

I did fail to mention the medication, which she was put on last night…Metoclopramide(10mg.) that I started this morning, about 45 minutes prior to her feeding. Interesting…she has only regurgitated 2 times since she woke at 5AM and also…I am feeding her while making her sit up, then I hold her to make her sit up for another 15 minutes… Anyway, now, she is making what sounds like very deep, long, loud burps…and then sometimes that is followed by her mouth filling with very thick & frothy, egg-white looking foam, which she then swallows. This is happening about every 20-30 minutes.

Dr. Joey :

I agree with your vets that Boric acid is probably not the problem. It is a relatively safe product and only if a dog ingested a lot would I be concerned. A bit sprinkled or licked should not be a concern. Even if it caused a problem at that point, it would not lead to a persistent issue that lingered until now.

Customer:

Agreed...as there wasn't that much injested...nor would it have carried over like it has.

Dr. Joey :

Metoclopramide can occasionally cause some neurological problems but usually hyperactivity and agitation, although I have had patients that get very depressed/lethargic. So, it is a potential cause.

Customer:

Hmm. Her 1st dose was this morning, so I haven't noticed those two issues, yet.

Dr. Joey :

But metoclopramide is a very good choice when we are dealing with regurgitation because it tightens the stomach's sphincter which can help when a dog has esophagitis (this is the most common cause of regurgitation in a dog that does not have megaesophagus... and I assume she does not since x-rays probably have been taken a lot).

Dr. Joey :

She could be treated for esophagitis which usually involves an antacid like omeprazole and then use of metoclopramide. Sometimes we also add in a protectant like carafate (sucralafate) in a liquid slurry.

Customer:

I believe the regurgitation is partially, or mostly attributable to the incubation during her surgery, as it started post surg.

Customer:

I've been giving her the Pepcid, ground up and sprinkled over her moistened food.

Dr. Joey :

The intubation may have caused transient throat irritation but not esophageal problems. But if she had some regurgitation of stomach acid then she could have developed esophagitis. So, still circles back to esophagitis. The pepcid is an antacid. that is a good alternative to omeprazole.

Customer:

yes. irritation from the incubation, but like you say, prior to the surgery, she had been vomitting forcefully for almost two weeks. I'm sure her esophegus must be raw.

Customer:

how bout I get back with you as the test results come in? I don't belive there's much more we can discuss till then??

Dr. Joey :

That sounds like a great plan. You can always reply to this question with an update at any point. However, we will no longer be in live-chat mode. But I will still respond.

Customer:

does this service work that way, or is it a one day deal?

Dr. Joey :

You can reply at any time at no additional charge and I have had conversations with some people that go months. My only request is if you can at this time submit a rating. It will close our live chat, but again, you can always return to the question and you can always post a followup. :)

Customer:

Excellent. Thank you and I'll be back in touch.

Dr. Joey, Board Certified
Category: Dog Veterinary
Satisfied Customers: 3776
Experience: 15 yrs in practice, specialist canine/feline medicine
Dr. Joey and 9 other Dog Veterinary Specialists are ready to help you
Expert:  Dr. Joey replied 1 year ago.
Hi Kevin,

I'm just following up on our conversation about Bingo. How is everything going?

Dr. Joey
Customer: replied 1 year ago.

He y Dr. Joey. Thanks for getting back with me. Bingo was diagnosed with Myasthenia Gravis and unfortunately contracted pnnuemonia over the last few days. Yesterday, we boarded her for IV antibiotic thereapy at the vet hospital. Last night however, she passed. Thank you for your help though, it was very appreciated.-Kevin

Expert:  Dr. Joey replied 1 year ago.
I am so terribly sad to hear about Bingo. What a long trial for both of you. Please take care. I'm sending you a big cyber hug. My thoughts are with you.

Most sincerely,
Dr. Joey
Customer: replied 1 year ago.
Thank you very much!

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Dr. Joey
Dr. Joey
Dog Veterinarian
3776 Satisfied Customers
15 yrs in practice, specialist canine/feline medicine