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She had a myotomy for cricopharyngeal dysphasia on August…

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She had a myotomy...

She had a myotomy for cricopharyngeal dysphasia on August 10th and has aspiration pneumonia she was discharged and readmitted on the 13th for vomiting and discharged on the 16th and readmitted for vomiting on the 18th having aspirated the vomit. She was in the ICU from the 18th-28th. She is on meropenem and many GI motility meds. We have to aspirate her feeding tube for air every three hours due to aerophagia when coughing. I don't seem to get any directions on what I should be encouraging in terms of activity and what not to be doing it's been 18 days home and she is still coughing and lethargic. Do take short walks? Let her rest all day and all night? Do I do couppage? With as severe as the pneumonia was is couppage dangerous for her? What is the best way help her get past this?

Veterinarian's Assistant: I'm sorry to hear that. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else important you think the Veterinarian should know about the dog?

Yes, will cisapride impede my dogs ability to burp?

Submitted: 8 months ago.Category: Dog Veterinary
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Answered in 9 minutes by:
9/17/2017
Dog Veterinarian: Dr. B., Veterinarian replied 8 months ago
Dr. B.
Dr. B., Veterinarian
Category: Dog Veterinary
Satisfied Customers: 22,830
Experience: Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you today.

As long as she isn't breathless or weak with activity, you could gently walk her around the garden for short periods of time (we'd not want to venture too far in case she became winded). Its just a case of taking it easy and not pushing her further then she is comfortable (and something they need us to monitor that since they won't do so themselves). Otherwise, as long as she has no history of chest trauma or bulla (pockets or air) in the lung tissue; then coupage could be used alongside steam treatment. To do this, you can take her in the bathroom while you run a hot shower. The steam will help loosen and clear some of the discharges congesting her. You can also use a baby nebulizer, but often dogs don't like things held up to their faces. That said, you can alternatively make a little ‘steam tent' with her in a dog crate and the nebulizer next to it with both under a thin bed sheet. To coupage, you just pat the chest firmly to loosen the discharge. (You can see a video of how to do so HERE @ www.youtube.com/watch?v=mjPMjlhluQ4). Finally in regards ***** ***** Cisapride, we don't tend to see burping issues but it can cause vomiting, diarrhea or abdominal discomfort in sensitive dogs. So, those would be the signs to watch out for. Otherwise her treatment sounds appropriate and we'd want to gently introduce a bit of activity if she is amenable to it.

Kind regards,

Dr. B.

******************************************************************************

I aim to provide best care for you just as I do for my own clients & their pets. If you have any other questions, please ask – I’m happy to help but please rate me with the **STARS** (or leave a written rating of 1-5; 5 being great) as this is the only way I am credited for my work by the site & this allows me to continue to help here. This is included in your question fee. Once you rate, your question will not close & you can still ask follow-up questions. Thank you. : )**

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Customer reply replied 8 months ago
Okay so there is a spot in her right lung that they are watching so maybe couppage is not appropriate. She had started to seem more energetic and her cough changed dryer I think so to help move the secretions I took her for 4 min walks and then two days later she had increased coughing and lethargy. She keeps peeing while she sleeps and she never had accidents in the house before surgery. I am struggling with the every three hour schedule to aspirate the air. Her total stomach volume is 600mls. I have pulled out 700 once. I don't understand why she is not burping. Have you treated a dog with aerophagia before?
Dog Veterinarian: Dr. B., Veterinarian replied 8 months ago

Hello again,

Aerophagia is very common in these cases because often they are trying to breathe in more to compensate for reduced oxygen uptake in the lungs. Burping isn't consistent with the cases and it can vary by dog. Otherwise, treatment for that isn't direct, its just a case of getting the pneumonia settled and that resolves as a side effect. So, treating the pneumonia is the focus here. And in regards ***** ***** much you aspirated, if your seal on the tube and syringe wasn't great that could explain it. Else there will be what she takes in as she swallows air during those sessions. But again all that tends to reduce if we can get the pneumonia controlled.

Finally, if there is a suspect bulla or lesion, then we would have to skip it as an intervention but the steam could be used as needed. But in regards ***** ***** keep it little and as often she will tolerate (as coughing 2 days later isn't going to be from that.

Best wishes,

Dr. B.

******************************************************************************

I aim to provide best care for you just as I do for my own clients & their pets. If you have any other questions, please ask – I’m happy to help but please rate me with the **STARS** (or leave a written rating of 1-5; 5 being great) as this is the only way I am credited for my work by the site & this allows me to continue to help here. This is included in your question fee. Once you rate, your question will not close & you can still ask follow-up questions. Thank you. : )**

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Customer reply replied 8 months ago
The coughing increased after two days of short walks. She has dysphasia and could not have any evaluation to see how the surgery effected the swallowing. Prior to the surgery she was a very burping farting dog and now she isn't which I believe is adding to the air issue. I am not sure if I am not asking the right question or if no one knows how to treat the aerophagia but aspiration every 3 hours 24/7 going on 3 weeks is not a sustainable way to live for her or us. My hours at work need increased to pay the bill from the ICU. She was vomiting due to pancreatitis which we learned on the the third admission. I understand the pneumonia is causing most of the problems and hopefully they will lessen it improves but I can't live my life scared she will die or vomit if she isn't aspirated on a 3 hour schedule. Does odansetron decrease burping?
Dog Veterinarian: Dr. B., Veterinarian replied 8 months ago

Hello again,

If she was able to burp before, we cannot exclude inflammation reducing her ability to do so but the drugs aren't likely to blame. So, you may need her vet to also treat for that and again there is no real treatment for aerophagia since its a side effect. So its something that needs to be monitored and addressed as you are until the primary disease is under control and thus it reduces. This is why she hasn't been put onto anything specifically for that. In the human medicine world, they just suggest aerophagic people stop swallowing air (not something we can really tell a dog). That said, one option that you may be able to try but is usually used for gas in the gut as opposed to air that is swallowed would be OTC simethicone or activated charcoal. Else you may need to see if the local referring vet can at least keep up on her treatment while you are at work (they tend to be less costly then ICU) as we just need time for the pneumonia to clear so this will too.

Best wishes,

Dr. B.

******************************************************************************

I aim to provide best care for you just as I do for my own clients & their pets. If you have any other questions, please ask – I’m happy to help but please rate me with the **STARS** (or leave a written rating of 1-5; 5 being great) as this is the only way I am credited for my work by the site & this allows me to continue to help here. This is included in your question fee. Once you rate, your question will not close & you can still ask follow-up questions. Thank you. : )**

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