Canine Laryngeal Paralysis
QUESTIONS & ANSWERS


FOOD & WATER
MEDICATIONS
COUGHING, MUCOUS, VOMITING
CHOKE COLLARS
PERMANENT TRACHEOTOMY




ONE OF THE ADVANTAGES OF THE LP EMAIL LIST IS THAT
YOU CAN DRAW ON OTHER PEOPLE'S EXPERIENCES FOR DEALING WITH LP
HERE ARE SOME OF THE TOPICS THAT HAVE BEEN DISCUSSED
AND THE ANSWERS THAT HAVE BEEN TAKEN FROM THE LISTERS EMAILS
THESE ANSWERS ARE BASED ON THE LISTERS EXPERIENCES AND DO NOT
REPLACE THE ADVICE AND INFORMATION PROVIDED YOU
BY YOUR OWN VETERINARIAN


FOOD & WATER
she had a good idea as far as the water goes. Give smaller amounts of water until she gets used to drinking differently. Sandy was able to drink normally right away, so I've never had to worry about that, but she still does occasionally eat her food a bit too fast and has to cough to get it out of her throat. She realizes it as soon as she does it, though, and fixes things right away. Cayman will learn pretty quickly how to moderate things.
I thought I had read that vets recommend doing that (raising food & water dishes) after surgery, however my vet said to do just the opposite. He said that it makes it harder to swallow water when the food bowl is raised.
When Byrd was released from the hospital, they told me I might want to raise the food and water dishes until she gets the hang of eating and drinking without gagging. I watched her closely for a few days and she had no problem, so I didn't bother raising the dishes. Her water "dish" is actually a large cup (32 oz.) which I keep filled so it is in a sense, raised. She occasionally does gag, but seems to have learned to manage by eating more slowly to avoid that.
I think you will find vets that support both sides. My normal day to day vet told me that we would have to elevate the dishes and put Kansas on soft food right after surgery. The surgeon that did surgery placed the bowls on the floor as soon as she started to eat again and had her on kibble within 5 days. I know in Kansas' case we have had no problems what-so-ever with her eating and drinking but I think that you will find others that have elevated will have the same thing to say. I think it is something that you need to discuss with your vet.
When I asked my vet if we needed to raise them, he said it wasn't necessary.

MEDICATIONS
Two years ago Sandy was sent home without any medication at all, but a lot of the dogs have been put on antibiotics after surgery just to be safe. I guess it depends on what each vet prefers.
The vet didn't put her on antibiotics after the surgery, but I would assume hat's because she was on steroids prior to the surgery and we are now weaning her off them.
Kansas was placed on an antibiotic as well as Cortisone and expectorant cough syrup following surgery. The Cortisone was to help delay or decrease the build up of scar tissue and the cough syrup was to encourage the release of mucous from her lungs since she still had an open tracheostomy
Some people on the list have tried to manage their dog's LP with medication and/or acupuncture, but I believe all have ended up having surgery done in the long run.
When I was trying to keep Kansas from having surgery we had her on some Cortisone along with Hycodan and Benedryl. For a time they seemed to work, but whether that was a function of the medication or the LP had not yet progressed to the point of my panic I don't know. What I do know is that in the long run the meds weren't enough and we had to do surgery so that Kan could stay with us

COUGHING, MUCOUS & VOMITING
She coughs almost as often, but it's just clearing mucous that starts heading down her windpipe, then she's fine. Breathing is fine.
I was planning on telling her to keep a close eye on him and make sure he doesn't aspirate anything.
I would call the vet since aspiration pneumonia can be a very serious problem
but she does seem to get a lot of mucous in her throat. My vet said that the surgery would allow for more accumulation of mucous and that and I should not let it concern me. I wonder if this could at the least be a contributing factor for the LP dogs who are having problems with vomiting.
about a week or 10 days later she vomitted terribly. It turns out hers was as a result of the antibiotics and the Prednisone.
When Pork had his surgery (10/16/96) it changed his respiratory & digestive tracts. He went thru a spell where he was gagging/coughing because of the mucous accumulation to the point he would bring up stomach contents. This is not considered vomiting but can result in bronchial infections or pneumonia just as easily as vomiting…..My point in telling you this is to help you see the difference between true vomiting & coughing/gagging causing stomach contents to be regurgitated. These two conditions are treated in different ways and unfortunately the vets don't have enough experience with LP that they would even think to question a client further when they say their dog is vomiting.
That's a good point about whether these dogs are truly vomiting or just coughing so hard trying to get the mucus up.
There are a couple of pretty common reasons why she may have vomited on an empty stomach. One is mucous accumulation (kind of like post nasal drip in people) which makes them feel nauseous and the other is a digestive problem (can't remember the name right now) that can be fixed by giving the dog a late night snack or if you are only feeding once a day feed at least twice a day. Old dogs digestive tracts are not as efficient as a younger dog. Adding digestive enzymes to their food helps also.
Maggie has only upchucked once since surgery and it was full of mucous. Just like with little human kids that swallow a bunch of it while teething: that stuff is icky, the stomach doesn't like it, and voila they barf.
As far as Cayman's vomiting just bile, I agree with Kathy as to what the problem probably is. Every once in awhile Irish, my five-year-old golden, vomits bile early in the morning, and that's usually when I'm later feeding them than usual or fed them earlier than usual the night before. If he does that, I feed them immediately and he has no more problems.

CHOKE COLLARS
One horrible thought I have always had is that, during the time of Obedience training for Sable's title, could the slip collar or choke chain have damaged her larynx? None of you mentioned this. Understand that I am not one to over use the choke collar but, yes, I did use it.
I asked my surgeon about this, and he didn't think LP was caused by choke collars

PERMANENT TRACHEOTOMY
There are cases of LP that just don't respond to the various surgeries. Such a case made its way it the list when Ellie's owner came to it looking for answers. Ellie, the Pug, had undergone surgery the previous week but her larynx kept collapsing. Ellie's vet had recommended a permanent tracheotomy, as it was the only way that she would ever get to come home. This was a very hard decision for Ellie's owner. He was desperate to save his little girl's life but he only wanted what was best for her. Several of the listers sent out email requests to other lists hoping to gain more information on dogs with permanent trachs. Here is some of what we learned.
The tracheotomy operation basically provides another outlet and inlet for air into the trachea bypassing the larynx. To accomplish this a short, broad tube is placed into the trachea and tied into the skin to hold it in place. For dogs with severe laryngeal disease this is often the best option to allow the animal to have an open airway. And most animals with a tracheotomy tube do quite well with them. The major concern is that the protective and filtering mechanisms of the upper airway (that remove dust, debris, and bacteria) are by passed. Thus, there is the increased risk of lung disease. The other primary concern is the fact that a foreign object is in the body and the body may react to it. There is always the risk of infection at the site of the tube insertion. In spite of these concerns, most dogs with a tracheotomy tube live fairly normal and healthy lives. Of course, there is a lot of management that goes along with it. No more swimming (don't water going down the tube), monitoring for infection of the lung and tube insertion site, and keeping the tube clean. It is not an innocuous procedure but it does provide most with a decent quality of life.
Your message was forwarded to PUGDOGS-L by a list member who specifically sent it to my attention. We have a 7-year-old female pug who went through this in Sept 1997. She was in the ICU at Iowa State University's Veterinary Teaching Hospital for 3 weeks total and had at least three different surgeries to Try and correct her collapsing trachea and laryngeal paralysis in addition to elongated palate and stenotic nares. The end result was a permanent tracheostomy.

At first we were disappointed and terrified. The first night we brought her home was awful, but slowly we've all managed to adapt. We still have to clean the tracheostomy site daily and trim the fur about once a week, but otherwise she is doing great. You can see before and after pictures of Choomia on our web site at: http://www.geocities.com/Heartland/Plains/2583/Choomia.htm

I want to thank Donna Clark for telling me about this list. Last fall, right before her 6th birthday, our female Pug, Choomia was diagnosed with laryngeal paralysis, collapsed trachea, elongated palate and stenotic nares. After several surgeries and 3 weeks in the ICU at Iowa State University's Veterinary Teaching Hospital, she was able to return home on October 6, 1997. Although the surgeon tried to reconstruct her airway, a permanent tracheostomy was the only viable alternative. We tried to Visit her often, but the 130-mile drive (one-way) was an obstacle. Luckily she received wonderful care from the staff and students at ISU.

Her first night home and subsequent days were very hard as all of learned to adjust. But a year later it is just a distant memory and Choomia has probably seen less of the vet than in previous years. We've had two Short visits with the surgeon, mostly because I've been nervous and not known what to expect, but both times he's been pleased with her progress and so are we. Her tracheostomy doesn't involve an "apparatus" or any suctioning, it is simply a slit cut in the front of her trachea about an inch long. We clean it about twice daily with cotton pads and saline solution, apply a dab of Vaseline, and trim the fur with a mustache trimmer about once a week. She sometimes has a little problem with phlegm, but a simple wipe does the trick. We keep travel kits in the cars, just in case, and otherwise things are pretty normal.

We're interested to see how she does this winter as last winter the tracheostomy site was still establishing itself and she was recovering from all the other surgeries associated. The cold air seemed to make it difficult for her to be outside, but we'll see how things go this winter.

If you have not visited Ann and Andy Dudler's page below, I urge you all to do so, It is really GREAT. The story and especially the pictures are most impressive. I know that if I had read Choomia's story back in May I would not have been so terribly frightened about the possibility of a permanent trach with Kansas. I was prepared to put her down if that had been needed. Now I know that the outlook is not so bleak.
About the human versus dog tracheostomy, I wish you could see Choomia as it's a lot easier to explain in person. She does not have a tube or apparatus, there is simply an opening in her trachea about an inch long. About twice a day we clean the area with cotton pads and a little saline. I keep the fur trimmed from the area with a mustache trimmer and that is really all the maintenance she needs. When she first came home from the hospital she had stitches and staples to deal with and the mucous needed to be cleaned all the time. We were up all through the night and it took a long time for her to be able to relax and be able to sleep (and the same was true for us). Slowly she healed and the stitches and staples were removed. Soon the cleanings were only every few hours and now it's only once or twice a day. It's a little gross, but Chester even helps Choomia out sometimes, by licking her tracheostomy site clean. We have to be very careful when we bathe her and she won't ever be a swimming dog, but otherwise she's pretty healthy and happy. She can't go for long walks or run very far, but she can chase squirrels out of the yard just as good as she ever did.
Some people in our kennel club had a Scottish Deerhound that needed a trach at a young age (about one year of age). He lived another several years -- they just tied a scarf over it when they took him somewhere and always had a towel for the drool
I had a 10-year-old black female that was diagnosed with laryngeal paralysis. It gradually became so severe that I had to opt for the surgery. Unfortunately, the surgery was not successful and basically fell apart. I was left with the option of a permanent tracheostomy. This Lab loved to swim and retrieve and I knew I would never be able to keep her out of the water. She would find it somehow and for sure drown, which I figured would be a worse way of dying than anything else. I decided on euthanasia, which was one of the most difficult decisions I ever had to make. She wasn't an old dog that was ready to go. I was so sure the surgery would have worked and this was a dog that was still healthy otherwise. I had assumed she would live a lot longer. I was very bitter with the surgeons who did the surgery but over the years I have realized that every dog recovers differently from this intricate procedure. Working at a Veterinary College I have seen some dogs live fine with a permanent trach. They just have to live a different lifestyle. I hope this helps in making one's decision easier.

1998-1999 LPLIST


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