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Tuesday, November 24, 2009

A Medical Mystery


Here's a truly bizarre case sent in by Erin. 

Okay, this is going to be kind of long so I apologize in advance. Let me just say first that we have had our 4yr old beagle, Daisy, to at least 11 different vets, including one internist in Jacksonville, FL as well as the vets at Auburn University's small animal clinic. Whew! :) Okay. After seeing all of those vets and endless tests we still do not know what's wrong with her. Here are her symptoms:


About every 3-7 days she'll have what I call an "episode" where out of the blue she'll start frantically licking the floor (or anything else), and swallowing in a very exaggerated manner. She'll make this sucking noise through her nose (not  reverse sneezing) and swallow more as if she can't get something down. She will also occasionally hack and cough up white foamy mucus and sometimes stomach contents. This can literally go on for HOURS. If we crate her she will lick anything she can get her mouth on, if we don't she'll eat fuzz off the floor that she wouldn't normally touch. If I hold her she'll just continue to lick the air or occasionally try and eat my hair. When she finally does settle down, usually from exhaustion, she'll wake up and cough a mucusy sounding cough occasionally. She's been examined by internists and we've talked to a neurologist and a behaviorist. Nothing....

Here are links to some videos that we took:


http://www.youtube.com/watch?v=kOROlB5oZeQ
http://www.youtube.com/watch?v=gFrzUzJ10YQ&feature=related
http://www.youtube.com/watch?v=jTVg-mXlGYI&feature=related

Anyway, on a normal day her breathing will sometimes sound congested and we're pretty sure she has allergies, although she hasn't been tested.



Tests we've done (all were normal):

Endoscopy (only throat and back of nasal cavity
Full blood panel (several times)
Esophogram
Throat Wash
Chest X-rays (several times)
Abdomen X-rays
Sinus X-rays (also looked at her throat)
Urinalysis and Fecal tests
Heartworm tests regularly

(I think that's it...)



Meds/things we've tried that don't work:
Many antihistamines (both prescription and over-the-counter)
Pepcid and Tagemet
Food Trials
Several Antibiotics
Reglan
Phenobarbital
Anti-nausea meds (both liquid and a shot during one of her episodes)
Valium during an episode


(That's all I can think of right now)

What works (don't know why):
Giving at least 1 Temaril-P per day, every day
AND/OR
During an episode, letting her completely gorge, and I do mean gorge, herself on grass. Sometimes she throws it back up, sometimes she doesn't. But she'll eat it for as long as I'll let her for the most part, or until her belly is bulging.


So basically, no one knows what's wrong with her and we've been dealing with this since we adopted her two years ago. It's stressful and it makes me sad that she has to go through this. Anyway, all the vets we've seen are stumped and any advice you may have would be wonderful. I'm just trying to get as many opinions as I can, hoping that someone may have seen something like this before. The vets at Auburn want to do surgery and explore her stomach to see if she has a sliding hernia, but a)it's extremely expensive b)they're not even sure that's what she has, so it could be pointless and c)I just don't know if I want to put her through it if we aren't sure it will give us an answer.

Anyway, sorry this was so long. Hopefully you can make sense out of it! I greatly appreciate any direction you may be able to give.

 
>
Wow, Erin, that’s some problem!  And I hate to tell you, but I’m not going to be much help either.  But there are a few things that I can try to share.  First, if this many specialists at this many high-quality locations can’t figure it out, then I hate to say it but I’m concerned that you won’t find answers too easily.  Honestly, I can’t think of any problems I’ve heard of that has gone through this many doctors without being solved.


One of my first impressions on watching the video was of an unusual kind of seizure activity.  But from what you’ve stated here, this has been ruled out by specialists and anti-seizure medication.  And all of the other tests would rule out many of the other things I would consider.

Temaril-P is medication mostly used for allergies.  It is a combination of a steroid and an antihistamine with the two of them working synergistically.  I do have one question, though.  You said that antihistamines alone don’t help.  Have you tried prednisone by itself?  I would suspect that it would help, which may indicate that this is an inflammatory process.  The inflammation could be caused by allergies or by some other situation.  If steroids help, they may the only solution that helps even a little.  As much as we don’t like to use them long-term, sometimes we have to.

Sorry I couldn’t give you a better answer, but you’ve already been to some of the top people in the field.  Good luck.
 




3 comments:

  1. Thanks for reviewing her info for me Dr. Bern. I keep thinking one of these days we'll come across a vet that has seen a case like this before. Maybe we still will! And if not, she'll be one for the records!

    ReplyDelete
  2. Dr. Bern,

    I remembered something else. The vets at Auburn said they think it could be a hiatal (sp?) hernia. However nothing showed up on the Esophagram or the x-rays. Do you think that her symptoms and test results could still point to a hernia? Auburn wants to do an exploratory surgery, but that's a big deal and I don't know if we want to put her through it if they can't assure us that they'll find something, or at least be a little more convincing.

    Thanks!
    Erin

    ReplyDelete
  3. Erin, what kind of food does she eat? Have you ever tried easily digestible food & does she eat too quickly.

    I have one that sometimes does the same including licking carpets.

    We call the spit-up a "blap & snort"

    Why would you want her opened up for exploratory? Is she unhealthy other than that? Have you tried different bowl heights?

    Good luck.

    ReplyDelete

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