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Sheltie: (~21 lbs)...vomiting..early morning hours, mostly mucus/bile

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My Sheltie is 13 y.o...
My Sheltie is 13 y.o. (~21 lbs). She began having periodic vomiting, usually in late evening or early morning hours, mostly mucus/bile, about 7 months ago. At that time, it became more frequent (including late afternoon) and my vet felt it was bilious vomiting. My dog was started on famotidine. When it continued over the next month, another vet in the practice added metoclopramide 2.5 mg q. 8 hrs, thinking that gastric stasis might be a factor. Also about 7 months ago when the vomiting began, my dog had been eating Science Diet Nature's Best Lamb and Rice (she was on that for about 2 yrs -- prior to that, was on a different brand of Lamb and Rice). When I realized the Science Diet brand contained soy, I switched to Natural Balance Lamb and Rice in case a soy allergy was a problem.
Since that time, my dog was improved, with an episode of vomiting (mucus, bile) ranging about every 4-5 days to every 2-3 weeks. Her medications continued to be famotidine and metoclopramide. About 6 weeks ago, the vomiting seemed to be ~1-2 x a week so she was switched from famotidine to omeprazole. My dog also started "dry heaving" more frequently, with nothing vomited. She would have episodes of this in which once she vomited, it would stop instantly.
About 3-4 weeks ago, my dog began this "dry heaving" -- abdominal muscles move (the vet observed an episode and said it appeared to her that it was more upper GI) -- almost constantly for 20 minutes or so at a time with breaks inbetween. Giving her a meal will cause this to stop. I talked to my vet about the possibility of helicobacter and after consulting with a specialist at Virginia Tech, we tried a 3 week course of amoxicillin, metronidazole, and omeprazole. My dog also started taking a sucralfate slurry q 8 hrs. My dog finishes the helicobacter regimen today.
Overall, the vomiting has improved (larger time intervals inbetween, small amount of vomit). But, while she seemed much improved this past weekend (no "dry heaves"), she vomited early Tues morning and over the past day since then, has frequent "dry heaving" again. As before, the dry heaving usually stops as soon as she eats (I feed her 3 meals per day; she was switched to Hills Prescription Diet i/d when she started the helicobacter regimen).
At this point, my vet and I appear to be at a loss as to what is going on. She had abdominal x-rays and an abdominal ultrasound that did not show any problems. Her blood work 3 weeks ago showed and increased WBC ct and neutrophils, with slight anemia (which is another reason we tried the helicobacter regimen). The other blood work was normal
I plan to bring her in next Monday for upper GI/lung x-rays and to repeat the wbc and blood work.
Does anyone have any ideas as to what my dog's problem is likely to be? After the end of today, her drug regimen is: metoclopramide, sucralfate, and omeprazole.
Could a food allergy be responsible? She was switched to lamb and rice food many years ago due to skin allergies (biting feet, hot spots) -- I'm guessing from chicken containing food -- and I'm concerned that the i/d diet with chicken could be contributing to the problem. If so, what would be a better option?
Would cisapride be a better drug than the metoclopramide?
Thanks very much.
Submitted: 7 years ago.Category: Dog Veterinary
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11/10/2010
Dog Veterinarian: Dr. Berry, Veterinarian replied 7 years ago
Dr. Berry
Dr. Berry, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 803
Experience: 26 years experience in small and large animal medicine and surgery.
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Hello. I'm Dr. Berry. Thanks for your question.

Either the cisapride or metocloperamide should work OK. If the metocloperamide is not working well try the cisapride.

There are a couple of diagnostic tools that might aid in finding out what the problem is. One would be endoscopy to take a look down the esophagus and into the stomach to see if there are any problems. Another would be to do an upper GI series that utilizes barium to visualize the stomach on x-rays to see if there are any problems. A barium study that utilized food mixed with barium can be fed and then serial x-rays taken and follow transit through the gi tract to see if there are any motility problems.
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Customer reply replied 7 years ago
Thanks, XXXXX XXXXX I was leaving work at that time and wasn't able to respond quickly. Given my dog's age, I don't want to subject her to an endoscopy unless I absolutely have to. Hopefully my vets will be able to do the GI series.<br />Do you feel what my dog is doing is consistent with a motility problem?  Also, could a food allergy be a contributing problem? Every time she eats, she rubs her face against the sofa and recently has been scratching at her face. Her skin is very flakey as well.
Dog Veterinarian: Dr. Berry, Veterinarian replied 7 years ago
It could be a motility problem as well as a problem with either the esophagus or stomach.

It could be a food allergy especially if she is rubbing her face. You will have to find a food that she has never had exposed to before to see if it works.
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Customer reply replied 7 years ago
One last question - my vet seems reluctant to try cisapride because the practice has little experience with it. From what I have read about motility problems in dogs, it seems that cisapride is often more effective than metoclopramide and may be better tolerated. Is that your experience as well? I would like to pass this along to my vet.
(I'm a pharmacy professor so I'm pretty familiar with the drugs in humans.
Thanks very much.
Dog Veterinarian: Dr. Berry, Veterinarian replied 7 years ago
I have not used any cisapride before but I would not hesitate to give it a try. Just because I have not used a drug before would not deter me from trying it. There are so many drugs available now we often have to expand our horizons by trying some new drugs especially if the old drugs are not working.
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Customer reply replied 7 years ago
Thanks for your response. I have a couple of journal articles to share with my vet on the topic. Hopefully we can find a solution that helps my dog.
If you think of anything else that might help, let me know.
Dog Veterinarian: Dr. Berry, Veterinarian replied 7 years ago
I hope you can find a solution also.
Dr. Berry
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Satisfied Customers: 803
Experience: 26 years experience in small and large animal medicine and surgery.
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