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Coughing - Temaril-P (Rx)
Dry cough in Sheltie
Chronic cough - Pom with hairballs
Coughing in small dogs
also see Respiratory problems
also see Heart disease
also see Trachea problems
Coughing -Temaril-P (Rx)Question: Dear Dr. Mike:
Thanks for getting back with me regarding my dogs coughing. I had not heard
about your suggestion to use a deworming medication. We live in South
Florida, so I don't know if this is an area where lung worms are prevalent or
not. Please let me know your thoughts on this for this region. I still have
not gotten the culture back yet, hopefully today. It has been 6 days since
they did the culture from the tracheal wash, so I am hoping that something
has grown out by now.
I am still hesitant about using the corticosteriods if even for a short term,
but if it is necessary, I will do it. What are the side effects of using
Temeril-P on short terms as needed to control the coughing?
Thanks again for your help!
JulieAnswer: Julie-
I was not sure what the geographic distribution of lungworms were, so I
looked them up in "The Textbook of Veterianary Internal Medicine" and the
most common lungworms affecting dogs, Pargonimus kellicoti and Capillaria
aerophila are both found in the South. While looking this up, I noticed
that the dosage for fenbendazole (Panacur Rx) that they recommend is 25 to
50mg/kg every 12 hours for 14 days, which is a lot longer than we have ever
used.Temaril-P (Rx) is a combination of prednisolone and
trimeprazine. Prednisolone is a cortcosteroid and trimeprazine is a
phenothiazine sedative. The side effects of corticosteroids include
increased drinking and urinating, increased appetite and sometimes panting
or decreases in immune function. The side effects of trimeprazine include
sedation, depression, lethargy, decreases in blood pressure and
occasionally paradoxical excitement.I have not used Temaril-P very much, because I don't like to use
combination medications when the two drugs have different dosing periods
when used separately. In this instance, the trimeprazine should be used
four times a day when used alone and prednisolone should be used every
other day, when possible. A lot of veterinarians really like Temaril-P and
seem to think it works better than either medication used alone, though.It is probably OK to use Temaril-P for short periods. We just use
prednisone when it seems appropriate and it has worked well when it was
necessary. I like to keep the use to less than five days or to use it
every other day, whenever possible. If that is not sufficient to control
the coughing, the lowest possible daily dosage should be used or other
medications used, if possible. Sometimes a short course of corticosteroids
gives relief for some time, though.I hope that the culture results were helpful.
Mike Richards, DVM
10/1/2000
Question: Dear Dr. Mike:
I am a recent subscriber to your service and am hoping you can answer some
questions.
About 6 weeks ago, my 3 year old male Sheltie began having an occasional dry
cough that was not productive. At first, I didn't think much about it
because sometimes days would go by without any occurrences at all. The
coughing started to become more regular (occurring about every other day, 2-3
times per day). I have noticed that he sounds a bit congested when he first
wakes up. Since he was a puppy, if he is outside running and playing, it
always takes him much longer to catch his breath than my other Sheltie. So,
because of these things, I took him to our vet who put him on antibiotics in
case it was an infection. We compete in agility and are at dog shows/trials
almost every weekend, so we thought he may have picked up some kind of bug.
Both of my dogs are given Bortadella vaccines every 6 months because of their
frequent exposure to other dogs. After completing the antibiotic, the
coughing was still occurring, still only every other day or so. I took him
back in and had a chest x-ray done. The Radiologist noticed some
inflammation on the film and said he had Allergic Pulmonary Disease. The vet
(not our usual one, but one of his partners) wanted to put him on Temaril P
but I said no because I didn't feel it was necessary to give a steroid since
this problem was not chronic and the coughing wasn't happening on a daily
basis. We tried TheoDur instead, but it didn't help. In fact, the coughing
seemed to get worse after 2 1/2 days of treatment. I took him back in this
week to have a tracheal wash. The cytology report shows nothing abnormal and
we are still waiting on the culture report to see if there is a bacterial
growth present that the other antibiotic just didn't cure.
Do you have any other suggestions or ideas of what this can possibly be?
Other than the coughing, he is acting completely normal and has tons of
energy and enthusiasm. The congestion sounds are still occurring when he
wakes up as is the coughing every few days or so.
I thought for sure it was going to be some kind of airborne allergy, but
according to the cytology report, it isn't that.
Any information or suggestions you can give will be greatly appreciated!
Thank you in advance for your time and input.
JulieAnswer: Julie-
You are doing the right things to find out what is going on. We usually go
ahead and use a good deworming medication, like Panacur (Rx), to try to
rule out parasite migration and lungworms as potential causes of the
coughing but that may not be as likely in all areas of the country.
Sometimes it is possible to find the eggs of lungworms on fecal exams but
not consistently, which is the reason for just trying the deworming. I can
remember two or three patients whose coughing stopped quickly after deworming.We do tracheal washes at our practice. When we don't find a cause for a
condition but feel that the problem really seems to be respiratory and not
cardiac in origin, we sometimes refer patients for bronchoalveolar lavage
(BAL), which is best done by someone with a bronchoscope, which we do not
have. It is considered to be a better way to obtain cells for examination
and can allow a diagnosis when tracheal wash does not.If the bacterial culture didn't grow anything it seems reasonable to try a
short course of prednisone or the Temeril-P to see if it will have a
beneficial effect prior to doing another invasive test procedure like the
BAL, though.We have a couple of patients with recurrent bronchitis that consistently
responds to antibiotics and about the same number of patients with allergic
bronchitis that doesn't respond to antibiotics but will respond to
corticosteroids. It is hard to differentiate between these problems and it
may take several attempts at tracheal wash or bronchoalveolar lavage to get
a good idea of what is going on. Given your dog's age, it seems worthwhile
to try to get a definite diagnosis, if possible, though.Good luck with this.
Mike Richards, DVM
9/25/2000
Chronic coughing - Pom with hairballs
Question: Dr. Mike
I was just reading through some of your Q&A's on Pomeranians and noticed an
article from someone named Christy 4-10-00 about her pom coughing excessively.
I have a 3 1/2 month old Pomeranian who has had a hacking, gagging cough for
almost as long as I have had her,
almost two months. The veterinarian has given her three different types of
medicines, and nothing has cleared it up.It's been 3 months and she may have solved the problem by now, I don't want
to seem intrusive but I have a Pom that had that bad coughing problem right
off and at 4yrs of age still does without the proper treatment. When my vet
first told me what to do I thought he was nuts but for the past 4 1/2 years
it's worked. HAIRBALL medicine. I don't know where he got that idea, but he
told me to either buy hairball medicine for cats or smear some petroleum
jelly in her mouth so she has to swallow it (I didnt' care for that idea, it
sounded nasty) Anyhow, when he first suggested this I took her to someone
else and my puppy suffered for 6mnths because of my disbelief. The other vet
couldn't solve the problem, when I finally tried the flavored hairball stuff
for cats it worked.
He said to be careful not to give her to much cause it will cause diarhea but
we've got it down pat, started out giving it to her once a week. Now is about
every 2-3 wks it seems to vary during seasons, but I can always tell when a
dose is needed cause the cough starts back up. I'm not saying she shouldn't
check for more serious problems, but if nothing else is discovered she might
want to give it a try.
Thanks for your Time
Michelle.Answer: Michelle-
I think that there definitely are some patients who cough (or possibly
retch in a cough-like manner) due to digestive problems rather than
respiratory problems. I haven't figured out a good way to tell which ones,
yet. Trying a course of gastrointestinal lubricants, or medications such
as cimetidine (Tagamet tm) or famotidine (Pepcid AC tm) seems reasonable
when the cough is chronic and non-responsive to therapy directed towards
respiratory disease. Perhaps your information may help someone else
struggling with this problem.Mike Richards, DVM
7/21/2000
Q: Dr. Mike, the vets believe my 14-year old toy poodle has Cushings disease. They did an ACTH stimulation test back in January, but because Buffy was not in discomfort and because of the required follow-up tests for medicating her, we decided not to treat her for it. For a while she has had a "hacking" sort of cough, but now it sounds "croupy" and she is having these attacks several times a day. The vet suspects this may be a result of the Cushings and wants to do a broncoscopy (sp) to examine her trachea. We are willing to start treating her for the disease, even if it means she is traumatized by the overnight stays for the tests to monitor the medication level. Is the brocoscopy necessary? Thanks for your time. G.
A: The most common causes of coughing in older small dogs are probably heart disease and collapsing trachea problems. Sometimes there are other problems, such as cancer or pneumonia. I think I would lean towards taking X-rays first since these are less invasive and rule out more problems but perhaps your vets have already done these or were planning to do X-rays at the time of bronchoscopy. If the X-rays are not helpful in delineating the problem then bronchoscopy is a good idea and can be very helpful.
Cushing's disease can contribute to heart problems and could cause coughing to develop in that manner. It probably is not helpful in cases of collapsing trachea, either, since it can lead to muscular weakness which could contribute to the problem.
I am not sure why overnight stays are necessary in monitoring the progress of treatment for Cushing's disease. We usually utilize ACTH response testing, which only takes 2 hours. Your vet may have a different testing protocol but you might want to be sure that overnight stays are part of the treatment. Monitoring dogs being treated with l-deprenyl may be better accomplished using the low dose dexamethasone response (LDDS text), which does take a total of 8 hours.
In dogs in which monitoring Cushing's is a major problem it may be helpful to consider treatment with either ketaconazole (Nizoral Rx) or l-deprenyl (Eldepryl Rx) (not the standard treatments) because they do involve a little less monitoring over time since are not as toxic as mitotane (Lysodren Rx).
Hope this helps.
Mike Richards, DVM
Last edited 08/30/02
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