\u201cThat\u2019s right, every day she\u2019s spitting up three to four times a day, maybe more. She gets so nervous and then, blammo! She cranes her neck like it hurts and little specks of bile seem to spray out of her mouth!\u201d<\/p>\n
![\"\"](\"http:\/\/www.dogster.com\/wp-content\/uploads\/2019\/09\/nervous-tummy-2.png\")
<\/p>\nPhotography \u00a9MediaProduction | Getty Images<\/p>\n<\/div>\n
Confusing symptoms<\/h3>\n
Later that morning, I was petting Flora on my examination table and still couldn\u2019t decipher her symptoms. For the past few months, Flora had been \u201cspitting up\u201d liquid bile primarily mid-morning and mid-afternoon. On a few occasions, Flora had awakened her owner in the middle of the night dry heaving in bed. Upon further questioning, I discovered Flora had recently become a little more \u201cnervous around strangers,\u201d and a neighbor had recently adopted a new puppy, causing Flora \u201cconsiderable distress.\u201d Flora seemed more \u201cclingy\u201d and was increasingly prone to \u201cshaking at the slightest loud sound.\u201d I was beginning to get a hunch of what may be going on.<\/p>\n
A thorough physical and neurological exam was normal. In-clinic blood, urine and fecal tests were all normal. Flora\u2019s owner agreed to allow me to take a couple of radiographs to make sure there weren\u2019t any abnormalities in her throat or stomach. We also performed a simple oral dye study to look for narrowing of the esophagus, swallowing issues, or unusual anatomy or tumors. These basic tests are the foundation of any chronic vomiting diagnosis.<\/p>\n
Fortunately, all of the tests were normal. Unfortunately, I didn\u2019t have a definitive diagnosis yet. That\u2019s how it is in medicine; sometimes the most important information is knowing what isn\u2019t<\/em> causing the symptoms. In Flora\u2019s case, I\u2019d eliminated the vast majority of serious, perhaps even life-threatening conditions in a single visit. To uncover her problem would now take a little experimentation.<\/p>\n My primary rule-out at this point was gastroesophageal-reflux disease or GERD, most likely caused or exacerbated by anxiety. While GERD is relatively uncommon, affecting less than 1% of dogs, it should be considered in cases of chronic vomiting or nausea. Many dogs with GERD or behavioral problems will extend their neck, shake, seek attention or solace from their owners, and many will dry heave or vomit. I was also concerned about GERD due to the fact that most of the episodes occurred several hours after eating. My plan was pretty simple: start Flora on a famotidine (Pepcid) trial, combined with breaking her meals into four to five smaller meals strategically placed throughout the day and a \u201cmidnight snack\u201d just before bedtime. I also suggested some behavioral modification to help ease Flora\u2019s anxiety around other dogs, strangers and noises.<\/p>\n \u2724 Two weeks later <\/strong>Flora was back and doing much better. She was still working on the behavioral modification, but had warmed up to the neighbor\u2019s puppy, much to her owner\u2019s delight. We decided to wean her off the famotidine and stick with the small, frequent meals. If Flora exhibited any signs of nausea or discomfort, I instructed her owner to give the famotidine immediately.<\/p>\n \u2724 One month later,<\/strong> Flora was almost back to normal. We\u2019d made a few tweaks to her diet (I boosted the fiber content of the food her owner called the \u201cbetween-meal snacks\u201d) and started a more Flora\u2019s case proves once again that sometimes the best test results are the ones that don\u2019t diagnose a disease. Too often, we expect instant answers with little effort or cost, when sometimes we need to slow down, be more thorough, thoughtful and patient. With my patients, the first thing I do is ensure a dangerous disease isn\u2019t present. Most of the time, a few simple diagnostic tests can rule out the really scary conditions and give us time to solve the pet\u2019s problems. Many times, pet owners are reluctant to proceed with diagnostic tests and eager to start treatment. The risk with this approach is you may waste valuable time on the wrong treatment. Your veterinarian is happy to explain why certain tests are needed, and, if not, find a veterinary team that will.<\/p>\n Also, give as much information and detail as possible. Flora\u2019s owner gave me all of the puzzle pieces I needed to assemble a diagnosis. If you feel your veterinary team isn\u2019t taking the time to listen to you, tell them. In nearly 30 years of practice, I\u2019ve learned my best \u201cdiagnostic test\u201d is listening. The bedrock of medicine is the patient history \u2014 be as flowery as possible!<\/p>\n Thumbnail: \u00a9Eriklam | Getty Images<\/p>\n Dr. Ernie Ward is an internationally recognized veterinarian known for his innovations in general small-animal practice, long-term medication monitoring, special needs of senior dogs and cats, and pet obesity. He has authored three books and has been a frequent guest on numerous TV programs.<\/em><\/p>\n The post The Curious Case of the Nervous Tummy<\/a> by Dr. Ernie Ward<\/a> appeared first on Dogster<\/a>. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren’t considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.<\/p>\n<\/p>\n \n","protected":false},"excerpt":{"rendered":"<\/p>\n The post The Curious Case of the Nervous Tummy<\/a> by Dr. Ernie Ward<\/a> appeared first on Dogster<\/a>. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren’t considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.<\/p>\n \u201cThat\u2019s right, every day she\u2019s spitting up three to four times a day, maybe more. She gets so nervous and then, blammo! She cranes her neck like it hurts and little specks of bile seem to spray out of her mouth!\u201d<\/p>\n Photography \u00a9MediaProduction | Getty Images<\/p>\n<\/div>\n Later that morning, I was petting Flora on my examination table and still couldn\u2019t decipher her symptoms. For the past few months, Flora had been \u201cspitting up\u201d liquid bile primarily mid-morning and mid-afternoon. On a few occasions, Flora had awakened her owner in the middle of the night dry heaving in bed. Upon further questioning, I discovered Flora had recently become a little more \u201cnervous around strangers,\u201d and a neighbor had recently adopted a new puppy, causing Flora \u201cconsiderable distress.\u201d Flora seemed more \u201cclingy\u201d and was increasingly prone to \u201cshaking at the slightest loud sound.\u201d I was beginning to get a hunch of what may be going on.<\/p>\n A thorough physical and neurological exam was normal. In-clinic blood, urine and fecal tests were all normal. Flora\u2019s owner agreed to allow me to take a couple of radiographs to make sure there weren\u2019t any abnormalities in her throat or stomach. We also performed a simple oral dye study to look for narrowing of the esophagus, swallowing issues, or unusual anatomy or tumors. These basic tests are the foundation of any chronic vomiting diagnosis.<\/p>\n Fortunately, all of the tests were normal. Unfortunately, I didn\u2019t have a definitive diagnosis yet. That\u2019s how it is in medicine; sometimes the most important information is knowing what isn\u2019t<\/em> causing the symptoms. In Flora\u2019s case, I\u2019d eliminated the vast majority of serious, perhaps even life-threatening conditions in a single visit. To uncover her problem would now take a little experimentation.<\/p>\n My primary rule-out at this point was gastroesophageal-reflux disease or GERD, most likely caused or exacerbated by anxiety. While GERD is relatively uncommon, affecting less than 1% of dogs, it should be considered in cases of chronic vomiting or nausea. Many dogs with GERD or behavioral problems will extend their neck, shake, seek attention or solace from their owners, and many will dry heave or vomit. I was also concerned about GERD due to the fact that most of the episodes occurred several hours after eating. My plan was pretty simple: start Flora on a famotidine (Pepcid) trial, combined with breaking her meals into four to five smaller meals strategically placed throughout the day and a \u201cmidnight snack\u201d just before bedtime. I also suggested some behavioral modification to help ease Flora\u2019s anxiety around other dogs, strangers and noises.<\/p>\n \u2724 Two weeks later <\/strong>Flora was back and doing much better. She was still working on the behavioral modification, but had warmed up to the neighbor\u2019s puppy, much to her owner\u2019s delight. We decided to wean her off the famotidine and stick with the small, frequent meals. If Flora exhibited any signs of nausea or discomfort, I instructed her owner to give the famotidine immediately.<\/p>\n \u2724 One month later,<\/strong> Flora was almost back to normal. We\u2019d made a few tweaks to her diet (I boosted the fiber content of the food her owner called the \u201cbetween-meal snacks\u201d) and started a more Flora\u2019s case proves once again that sometimes the best test results are the ones that don\u2019t diagnose a disease. Too often, we expect instant answers with little effort or cost, when sometimes we need to slow down, be more thorough, thoughtful and patient. With my patients, the first thing I do is ensure a dangerous disease isn\u2019t present. Most of the time, a few simple diagnostic tests can rule out the really scary conditions and give us time to solve the pet\u2019s problems. Many times, pet owners are reluctant to proceed with diagnostic tests and eager to start treatment. The risk with this approach is you may waste valuable time on the wrong treatment. Your veterinarian is happy to explain why certain tests are needed, and, if not, find a veterinary team that will.<\/p>\n Also, give as much information and detail as possible. Flora\u2019s owner gave me all of the puzzle pieces I needed to assemble a diagnosis. If you feel your veterinary team isn\u2019t taking the time to listen to you, tell them. In nearly 30 years of practice, I\u2019ve learned my best \u201cdiagnostic test\u201d is listening. The bedrock of medicine is the patient history \u2014 be as flowery as possible!<\/p>\n Thumbnail: \u00a9Eriklam | Getty Images<\/p>\n Dr. Ernie Ward is an internationally recognized veterinarian known for his innovations in general small-animal practice, long-term medication monitoring, special needs of senior dogs and cats, and pet obesity. He has authored three books and has been a frequent guest on numerous TV programs.<\/em><\/p>\n The post The Curious Case of the Nervous Tummy<\/a> by Dr. Ernie Ward<\/a> appeared first on Dogster<\/a>. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren’t considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.<\/p>\n<\/p>\n \n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-872","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nWhat is GERD?<\/h3>\n
\nregimented physical activity program (a 30-minute daily walk \u201crain or shine\u201d), along with \u201cpuppy playtime\u201d with the neighbor\u2019s dog. She\u2019d only needed the medication twice during the four weeks.<\/p>\nGetting results<\/h3>\n
About the\u00a0author<\/a>:<\/h3>\n
Read more on dogster.com<\/a>:<\/h3>\n
\n
<\/p>\nConfusing symptoms<\/h3>\n
What is GERD?<\/h3>\n
\nregimented physical activity program (a 30-minute daily walk \u201crain or shine\u201d), along with \u201cpuppy playtime\u201d with the neighbor\u2019s dog. She\u2019d only needed the medication twice during the four weeks.<\/p>\nGetting results<\/h3>\n
About the\u00a0author<\/a>:<\/h3>\n
Read more on dogster.com<\/a>:<\/h3>\n
\n