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! Julie
Answer: 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. 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
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.
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
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...