Armchair vets, I need some ideas on differential diagnoses - Doberman Forum : Doberman Breed Dog Forums
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post #1 of 12 (permalink) Old 07-24-2019, 10:33 AM Thread Starter
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Armchair vets, I need some ideas on differential diagnoses

First - I have taken her to the vet.

Bella is 11 years old, and aced her last checkup (2 weeks ago) like a champ - got her vaccinations updated, everything was fine. Last night when she was sleeping, she'd wake up gagging and coughing, then go back to sleep. This happened at least 6 times that I recall. This morning, she didn't eat. She's normally a voracious like "slow the heck down so you don't bloat" kind of dog. She just wouldn't even look at food this morning. Drank a bunch of water. Then she started breathing kind of funny. Not rapid, but like air was hard to come by. Almost snoring a bit. She's definitely not as boisterous as she normally is - generally speaking she is obnoxious - and she has been laying on her keel sleeping and shaking. She has whined a few times (maybe she's constipated??). Here's a video of what she's been doing at rest - a few notes, she is a blue who has just been to the vet, hence her poor-looking coat around the back end - she blows dander when she's nervous. She did lose a little weight - down 2 lbs (she normally weighs around 60 lbs). Please ignore my messy floor - she pulled yarn out of a bag looking for her "baby" (a toy) a few days ago. I haven't caught the coughing/gagging on camera yet because usually the episode is over before I can get the phone unlocked.

Took her into the emergency vet this morning. Exam checked out fine, one eye a little cloudy, but otherwise all sounded good. She did eat some snacks at the vet. I insisted they do an X-ray though her heart sounded fine and the rate was normal. Temp slightly up but he said it could just be stress from coming into the vet. Vet said no obvious DCM or cancer on X-ray, although they are going to send it off to the radiologist. She WAS at the kennel last week when we were on vacation, so the vet said it could be a virus, but she hasn't coughed when she was awake, only after laying on her side for any period of time. She is fully vaccinated, and the kennel is pretty strict with those, so...for what that's worth. Vet said her heart was actually a little small and not enlarged like he would expect with DCM. He moved her neck around etc and she was fine. She does have a breast lump, but it hasn't grown, and again - no obvious cancer on the xray.

She's extra-velcro-y too. Usually she'll follow me around the house like a normal doberman, but when we go down the stairs she'll run down the stairs and back up around me and repeat until I get to the bottom of the stairs. Today she's just following me down the stairs at my heels. When she wakes up, she'll stare at me extra much - usually she's not a dog that is keen on eye-contact...she just can't even lay still for that long.

Could it be a virus? I suppose, but man, that's not my first suspicion when I have a sick old doberman that's not just a touch of diarrhea or something like that. Can dogs get heartburn/acid reflux? The coughing and gagging first points to heart in dogs, I know, but it sounds just like I do when I lay flat (and have eaten the wrong foods). Any other ideas? She is never off leash outside, so I doubt she has gotten into anything. We didn't go for any real walks yesterday, just outside to potty. Her stool is a little dry...could she just be constipated? Seems like that wouldn't cause the coughing and gagging but it could cause reflux I suppose. She's also kind of tucking her stomach and standing funny. I just got a video of that, I'll share that shortly.

Any and all ideas are welcome!
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Last edited by oberonandbella; 07-24-2019 at 10:40 AM. Reason: more data
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post #2 of 12 (permalink) Old 07-24-2019, 11:00 AM Thread Starter
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Here's the video of her weird standing and tummy tucking etc.
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post #3 of 12 (permalink) Old 07-24-2019, 11:47 AM
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Well, here's one to ask your vet about if the coughing etc continues. I have a 13 year 7 month old Dobe and recently (last 8 months more or less) he has had a wheeze--sounds almost like he's gasping for breath--but in the time he's had the cough/wheeze--complete now with old man bark--raspy and no volume he's had two visits to the cardiologist--for his age the cardiology for both echo and Holter have been pretty normal--cardio function is slowly deteriorating but his age is slowly increasing--all the cardio is well controlled with standard cardio drugs--not CHF and not fluid in or around heart or in lungs. Just before the last echo a friend of mine was driving me crazy telling me these weird sounds he makes when he breathes were cause by the fact he wasn't getting enough oxygen. (By the way--his vet, at the clinic where I work, had already told me what he was reasonably sure it was).

So I took him in with me and got his vet to take another look in view of the most recent echo and Holter. What he seems to have is laryngeal Paralysis--this is a disease often seen in older labs--and it was what I thought was going on when it first started. We checked to see what his oxygen levels looked like and he has oxygen levels up close to 100 % saturation--definitely getting enough oxygen. I think every vet in the clinic (6 out of the 7 employed there) came and looked and listened and the consensus was that it was laryngeal paralysis--and the reason we don't have anything on it in Dobes is that they basically don't live long enough for it to show up. It does tend to only show up on older labs.

Don't know if your bitches symptoms are anything like this but without checking for fluids collecting in and around the chest/lungs and heart it's the only thing I can suggest.

Good luck.

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post #4 of 12 (permalink) Old 07-24-2019, 12:40 PM
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Has she had an echo or holter? X-ray isn't really enough for me to feel comfortable ruling out DCM or assessing true cardiac health.

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post #5 of 12 (permalink) Old 07-24-2019, 01:39 PM Thread Starter
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Well I just heard back from the vet. It seems that she has the beginning stages of pneumonia...who'd have thought! Could that be confused with other pulmonary edema coming from a heart issue? I'm not sure, but we're going to start the antibiotics to see if we can get her out of this funk.
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post #6 of 12 (permalink) Old 07-24-2019, 02:15 PM
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Pneumonia and fluid accumulation due to congestive heart failure can go together, but they can also be mistaken for each other at first.

I personally would feel more comfortable if I had more specific heart testing than just an x-ray. My understanding is that the heart enlargement is one of the later symptoms of DCM, and you don't have a previous xray of what her heart looked like in the past to compare with the current one.

I would guess that if they are calling this pneumonia they are seeing inflammatory cells in whatever sample they collected, maybe even bacterial growth where it doesn't belong. I don't think an antibiotic would hurt, and is probably the most cost effective way to proceed. The presence of pneumonia will certainly put strain on her heart and worsen her condition, so it would have to be taken care of anyway. If you don't see improvement or certainly if her condition gets worse (over the next 4 or 5 days), I think you should explore the issue further.

But as your title implied, I am definitely armchair.

Last edited by melbrod; 07-24-2019 at 03:17 PM.
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post #7 of 12 (permalink) Old 07-24-2019, 02:21 PM
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Well, I am glad you got a diagnosis. I have had pneumonia.Twice. It sucks...

I now get a Pneumococcal vaccine shot. I'm not big on medication, but as one get's older, it becomes more prevalent and more deadly. Plus Medicare pays for it!

In any case, I hope the antibiotics work for Bella.

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post #8 of 12 (permalink) Old 07-25-2019, 08:37 AM Thread Starter
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Thanks all Sorry I was responding quickly just trying to give a quick update.

The vet did not do any sort of fluid collection. So we don't know for sure, just based on the xray. If I don't see improvement in a few days I'll definitely be going back for a holter/echo. I had to push them to do the xray even (I'm not sure why but they seemed anxious to say it was "just a virus"). There's a downside to being very keyed into your animals, you tend to detect things very early and people think you're crazy.

I just realized I was wrong, she's not 11, she's actually 12 this year so I get that I don't have much longer with her anyhow, but I feel like they might have been more aggressive with a younger dog. We moved a year ago, and this wasn't the vet she grew up with, so maybe it's just a lack of Dobe experience that's causing the reticence on the part of the vet, I don't know. Or the fact that I looked tired and not well dressed because she kept me up all night. I'm just venting a bit now. I guess I'm used to my old vet who had dobermans and was great to work with as a result.

Thank you armchair vets and responders - I appreciate the comments. She ate her food after I wetted it down and is taking her antibiotics like a champ. Her cough seems a bit worse today, but it's early yet for anything to kick in.
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post #9 of 12 (permalink) Old 07-25-2019, 09:46 AM
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Glad she’s on the antibiotics! At her age, pneumonia would be a real whammy and make her feel terrible, plus it’s scary to older humans to have trouble breathing so you can add in the anxiety factor, which is nothing to scoff at.

Maybe you could cook her up some chicken and broth for her nutrition for a few days. Boil the whole chicken with bones and giblets for best nutritional value and then remove the bones. It’s research proven to be healing and gets a lot of fluid in which is especially important. Senior dogs, just like humans, lose their sense of thirst and fluids are vital in healing pneumonia.

Also, adding humidity to the air where she’s sleeping with one of the ultrasonic devices would really help. Pleeeeease keep us posted on that beautiful lady!! So great you were aggressive in finding out what was wrong.

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post #10 of 12 (permalink) Old 07-25-2019, 10:22 AM
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A nice read on the causes for pneumonia in dogs , After reading what your vet diagnosed your dog , then had to look up the reasons for this .

Bacterial Pneumonia and Bronchopneumonia in Dogs
By Krista Williams, BSc, DVM; Cheryl Yuill, DVM, MSc, CVH Infectious Diseases, Medical Conditions, Pet Services
What is the respiratory system?
In general terms, the respiratory system is divided into two parts. The upper respiratory tract consists of the nose, nasal sinuses, throat, and trachea (windpipe) while the lower respiratory tract consists of the small airways (bronchi and bronchioles) and the alveoli (the small air sacs deep in the lung tissue where oxygen exchange occurs).
What is pneumonia?
bacterial_pneumonia_in_dogsStrictly speaking, bronchopneumonia is an inflammation of both the lungs and the airways (bronchi and bronchioles), while pneumonia is an inflammation of the lungs or lower respiratory tract. However, the terms are often used interchangeably.
What causes pneumonia?
In general terms, inflammation in the lungs is the response of tissues or cells to injury, irritation, or infection.
More specifically, most cases of pneumonia in dogs are caused by a bacterial infection. The most common bacteria that cause pneumonia in dogs are Bordetella bronchiseptica, Streptococcus zooepidemicus, Pasteurella multocida, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Mycoplasma species.
B. bronchiseptica is highly contagious and may spread easily to other dogs. It usually causes 'kennel cough', an infection of the trachea and bronchi, but can spread deeper into the lungs, especially in young or old dogs, or dogs with a compromised immune system. Most other causes of bacterial pneumonia are not particularly contagious to other dogs.
Sometimes, dogs develop bacterial pneumonia as a secondary infection. In some of these cases, the primary or underlying cause is a viral infection such as influenza, parainfluenza, or canine adenovirus type-2. In other cases, irritants such as tobacco smoke, smog, or other inhaled pollutants may be the underlying cause that predisposed the dog to a bacterial infection.
Are there any risk factors for developing bacterial pneumonia?
Any disease or condition that affects the respiratory tract can predispose a dog to developing bacterial pneumonia. Some risk factors include conditions that cause difficulty swallowing or problems with regurgitation such as laryngeal paralysis, megaesophagus, cleft palate, chronic vomiting, altered states of consciousness, and tumors of the respiratory system.
Dogs with an immune system disease or those that are on immunosuppressive drugs are at an increased risk of bacterial pneumonia, as are dogs with severe metabolic disorders such as kidney failure, uncontrolled diabetes mellitus, Cushing's disease, or Addison's disease.
What are the signs of bacterial pneumonia?
Dogs that have bacterial pneumonia usually:
have a high fever
have difficulty breathing
have decreased exercise tolerance (tire easily)
are lethargic
have a cough
Other signs that may be present include a nasal discharge, loud breathing, rapid breathing, weight loss, anorexia, and dehydration.
Could these signs be caused by something else?
Some of these signs are common and are not specific to any one disease. Non-infectious respiratory disease such as chronic obstructive pulmonary disease (COPD), heart disease causing pulmonary edema, and lung cancer can also cause some of these symptoms. Before reaching a diagnosis of bacterial pneumonia, your veterinarian will conduct a thorough physical examination and recommend a series of diagnostic tests.
How is bacterial pneumonia diagnosed?
Your veterinarian may suspect bacterial pneumonia based on the presence of the signs listed above, combined with the results of a physical examination, especially if abnormal lung sounds are heard when listening to your dog’s chest with a stethoscope.
A series of tests may be required to confirm the diagnosis and to exclude other diseases that could be causing the symptoms, including:
CBC and biochemistry profile. These blood tests will assess the general health of your dog, and specific blood or fecal tests may be recommended to rule out parasitic diseases such as heartworm or lungworm. Specific blood tests to rule out serious metabolic diseases may be necessary.
Thoracic radiography (chest X-ray). Radiographs often show characteristic changes in the lungs, and may be helpful to eliminate other types of heart or lung disease.
Cytology using bronchoscopy. A small fiber optic camera called a bronchoscope is used to directly examine the inner surfaces of the airways in an anesthetized dog. After completing the visual examination, cytology samples (samples of the cells lining the bronchi and bronchioles) can be collected for microscopic examination and for bacterial culture and sensitivity testing.
Tracheal lavage. The pet is usually placed under sedation or anesthesia, and a thin, flexible, sterile catheter is passed into the area being investigated. A small amount of sterile fluid is flushed forcefully into the area and then promptly suctioned or aspirated back out. The recovered fluid contains mucus and a small number of cells that can be cultured for microorganisms and examined under the microscope.
What is the treatment for bacterial pneumonia?
The appropriate antibiotic treatment is determined by the results of the culture and sensitivity tests. These tests identify the specific bacterial species causing the infection and which type of antibiotics will combat this infection. Since the results of culture and sensitivity testing will not be available immediately, your veterinarian may begin treatment with a broad-spectrum antibiotic, such as doxycycline or amoxicillin, while awaiting the test results. It may be necessary to change the medication once the results are available. Your veterinarian will choose the appropriate antibiotics for your dog's particular situation.
"Medications may be required for a prolonged period of time, depending on the specific type of infection and the seriousness of the condition."
If your dog has respiratory distress or is dehydrated or anorexic (complete loss of appetite), hospitalization for oxygen therapy and/or intravenous fluids and medications may be necessary.
If your dog is stable enough to be treated as an outpatient, your veterinarian may also prescribe bronchodilators, expectorants, or other medications to control specific symptoms. Medications may be required for a prolonged period of time, depending on the specific type of infection and the seriousness of the condition.
Your veterinarian may also recommend several daily sessions of brief exercise to help loosen secretions and promote coughing out of inflammatory debris. Apart from these short sessions, your dog's activity should be restricted. Another helpful home treatment is to place the dog in a closed bathroom with a warm shower running for about 15 minutes up to 3 times per day. This increase in humidity has the effect of thinning out the mucus in the airways so that it is coughed up more readily (see handout "Techniques for Nebulization and Coupage in Dogs" for more information).
What is the prognosis for bacterial pneumonia?
The prognosis depends on the severity of disease and whether there are any predisposing factors. The prognosis is generally good for uncomplicated bacterial pneumonia. The prognosis for animals with predisposing factors depends on whether the risk factor can be treated or resolved. If the risk factors cannot be resolved, recurrent infections may occur. The prognosis for young or geriatric animals, patients with immunodeficiency diseases, or patients that are debilitated is guarded.
Contributors: Krista Williams, BSc, DVM; Cheryl Yuill, DVM, MSc, CVH
© Copyright 2018 LifeLearn Inc. Used and/or modified with permission under license.

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post #11 of 12 (permalink) Old 07-25-2019, 11:56 AM
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My previous senior Doberman Hannah experienced something like this. She was 9 or 10 and already diagnosed with mild DCM, and when she started with some weird breathing I freaked out and assumed it was CHF. What it really was was a respiratory illness, which she had been vaccinated for and she had never been around other dogs other than our other dog (she was very reactive to strange dogs). However, our puppy was around other dogs, and while he didn't have symptoms as the time, several weeks later became symptomatic. She was fine after being treated for the respiratory illness (I can't remember if it was kennel cough or dog flu or something similar as it was years ago).

I agree with everyone else though that a more thorough examination to check her heart via holter and echo and do actual testing to identify if she has a virus or infection is important to rule out something more serious and to make sure she gets the most effective treatment, especially considering her age.

I hope she feels better, its always hard when you have a sick dog and aren't getting the information you need from your vet. Good job advocating for her, she is lucky to have you.
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post #12 of 12 (permalink) Old 07-29-2019, 04:14 PM Thread Starter
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Thank you all. This is the first I had even heard of the possibility of dogs getting respiratory illnesses like this. I mean, I guess I knew about Kennel Cough but I always thought it was one of those things that you vaccinated for and were done with. I suppose that's stupid of me to think that way since we get all sorts of things but I've never seen a dog do this and I've had dogs my whole life. I guess I've just been lucky.

We're on day 4 of the antibiotics and she's still coughing and sneezing (and eating the result, dogs are so gross sometimes) like a fool. She is perky though and is back to wolfing her food down. The mucus is clear/white, so I suppose that's a good sign (at least it is in humans). Her older "sister" doesn't seem to have any signs of it (thank heavens, she's 16 and I really don't need two coughing sick dogs).

I'm calling the vet back today for an update and to push for the fluids to be tested. She seems to feel just fine now, other than the coughing and sneezing. She's sleeping a little more than normal, but I'd expect that. She mainly coughs after jumping off the couch and running to the door to sound the alarm about people walking by so we've been trying to keep her quiet (although that's really hard to do with this dog!)
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