Canine Laryngeal Paralysis KANSAS' LP JOURNAL OUR DAILY DIARY
KANSAS HAS LARYNGEAL PARALYSIS
LARYNGEAL PARALYSIS by Dan Reimer DVM
SURGICAL OPTIONS
HOW MUCH DOES IT COST?


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KANSAS HAS CANINE LARYNGEAL PARALYSIS

On February 15, 1998, my almost 12 year old Kansas started frequent, excessive and hard edged panting along with throat clearing that sounded a lot like the honking of a goose. I will try and describe the panting and "honking" so that you will be able to see the difference between what is normal and what is not. This is hard to do without benefit of sound but I will try my best. The panting can happen at anytime, not just when she is hot or has been exercising. When she inhales there is a "harsh edge" sound to, similar to the wheeze of an asthmatic. This panting is more pronounced and prolonged when she is excited or stressed. The "honking can also happen at any time and sounds something like a loud "HRRRAAACH". This clearing can be a one time deal or can be repeated. These episodes did not last very long but were noticeable enough for me to start keeping a log and to keep a close eye on her. I went to my books as well as the Internet to try and find some answers. The pickings were slim but I finally found one small paragraph that mentioned Laryngeal Paralysis, it sounded like it just might be a fit. About a week later I had a Veterinarian who was helping her brother with his puppy search come to my home. When she heard Kansas pant she said "laryngeal paralysis" once again leading me in the direction of that diagnosis. I then went to my two Labrador Email lists and asked if anyone had information that might be helpful. Once again the responses I got confirmed what I feared. I also learned that there is an LP (Laryngeal Paralysis) email list so I subscribed to it.

On March 14, I went to see my own Veterinarian and unfortunately my diagnosis was immediately confirmed. Kansas did indeed have LP. Just what is LP? Thatís a good question. There is so little information available that it is hard to find a non-technical explanation. From what I can understand, LP is sometimes seen in older dogs and is caused when the nerves and muscles of the larynx do not function properly, one or both sides of the larynx do not open or close as the should, impairing breathing.

Now that we had a diagnosis we had to figure out a course of action. The options open to us were; scraping the inside of the larynx, stitching open one or both sides of the larynx so that it would not close or trying various medications to see if we could control it. Since Kansasí episodes are not severe at this time we have opted to try medications and leave the surgery option open (tacking open one side of the larynx) should the need arise at a later date. Kansas was put on 5mg of Hycodan every 12 hours. On days that this does not quite to the trick we add 25mg of Benedryl as needed. So far this is working. There are days when she might have as many as 3 episodes lasting no more than 10 minutes each to days when she is totally episode free. We just take each day as it come and do our best.

As I said earlier, I have started a log or journal to record just what is happening. I will be putting parts of that journal on this page as the days go by. This journal will touch on what we are going through and will touch lightly on good days but will probably dwell more on the not so good ones. The fewer and more time between dates means that things are going OK and are pretty much under control. My Vet has also written an article on LP and it is included here.

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LARYNGEAL PARALYSIS
Daniel Reimer, DVM

Laryngeal Paralysis is a condition seen commonly in older Afghans, setters, springer spaniels, greyhounds, and Labrador retrievers. It can happen to any breed dog, but is especially common in the large breeds. It can be a terrible condition to watch any dog suffer through. They are very uncomfortable during an episode, and in severe cases can develop cyanosis (a blue color to the gums) from lack of oxygen. They can collapse and even die from this condition.

Clinical signs can really vary based on the severity of each dog's problem. They may just have a voice change in the very early stages, which may progress over time to excessive panting, especially during any exercise or excitement, or even just coughing. These are common signs with other throat infections and some relatively minor problems. This can progress well beyond this to stridor (a harsh, high pitched roaring sound heard mainly on inspiration). When this sign starts to develop, most people realize something real is happening. Their dogs may go further to develop exercise intolerance, collapse, and cyanosis.

The condition is caused by some condition affecting the recurrent laryngeal nerves leading to a loss of their function. These nerves innervate the larynx allowing it to open up (abduct) when a dog is taking a breath. When the condition occurs, a dog's airway is narrower than it should be, which is especially hard on an animal when it needs more air (like during exercise or excitement). The body needs more air, but it can't get it, so an animal pants and breathes even harder. The larynx may have a great deal of swelling associated with this, which even further narrows the airway. If it severe enough, the animal can pass out from lack of oxygen. We are not sure exactly what causes the nerves to loose function, but some of the causes include hypothyroidism, brain lesions (including tumors, inflammation etc.), and polyneuropathies. In most cases a cause is never found.

Medical treatments are only palliative and all are aimed at reducing swelling, or just calming down the dog. Rest, corticosteroids, antihistamines, sedatives may all have beneficial effects. If the condition continues to get worse, to the point where it becomes debilitating, surgery is the next step. The goal of surgery is simple: open the airway. There are various different types of procedures done to "tie back" the arytenoid cartilage or open the airway. Individuals seem to respond differently to the surgery. In some cases they do very well post-operatively. Unfortunately, some dogs are very prone to inhalation pneumonia afterwards, as any surgery in this area may affect the swallowing mechanism.

In short, this can be a truly frustrating and disheartening condition. Our goal is always to keep the dogs as comfortable as possible, and in most cases surgery becomes the only way to achieve that, but even that can have serious complications.

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SURGICAL OPTIONS

It is very common for dogs with LP to have to undergo surgery in order to alleviate the problem. Here is some information that I have compiled regarding the surgical options.

There are two basic surgical approaches commonly done for Laryngeal Paralysis: Extralaryngeal (from the outside of the throat) and Intralaryngeal (usually through the mouth).

The most common technique seems to be the Extralaryngeal technique which involves cutting through the neck, close to the jugular, isolating the laryngeal "folds" and stitching one or both of the folds open. It seems to be more common to tie just one of the folds back as it reduces post operative complications. These complications can include swelling and hemorrhage on the short term and on a long term basis the aspiration of food or water that could lead to aspiration pneumonia. Most dogs will have a tendency toward aspiration (especially of water) for a short time following surgery, but they will become more adept at drinking as time passes and have fewer aspiration episodes. It is recommended that dogs who have had the tieback surgery have their food and water dishes elevated so that they do not have to bend their necks when they eat or drink. It is far more important to elevate a dogís food dish if it is a "vacuum cleaner" type of eater - in other words inhales the food rather than eats it. Also several small meals instead of one or two large ones is recommended so that the dog can learn to eat without severe side effects. The advantages of the tieback are that the dog does not build up scar tissue in the larynx which could cause severe complications later on and it is a far more permanent solution to the problem than are other procedures.

The Intralaryngeal techniques include a resection of the vocal folds or a resection of one or both sides of the vocal laryngeal folds. This procedure is often done through the mouth. Where this is a less invasive surgery, complications can arise from scar tissue forming in the larynx and this techniques involves performing a tracheotomy which will compensate for the swelling and possible hemorrhage that will occur following surgery. Also these techniques are not as permanent as is the tieback surgery.

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HOW MUCH DOES IT COST?

The cost of a good Vet in Southern California is not cheap but I believe that is some of the best spent money going. Here is a tally of the dollars spent on Kansas' LP and throat reconstruction to date.

DATEITEMCOSTTOTAL
3/14Initial examination and Thyroid test$ 78.00$ 78.00
3/14Hycodan 5mg$ 17.00$ 95.00
3/25Hycodan 5mg$ 17.00$ 112.00
4/14Hycodan 5mg$ 17.00$ 129.00
4/22Prednisone 20mg$ 14.00$ 143.00
4/22Hycodan 5mg$ 17.00$ 160.00
4/29Prednisone 20mg$ 14.00$ 174.00
5/1Canine Panel (bloodwork)$ 83.00$ 257.00
5/5Pedicure$ 15.00$ 272.00
5/5Gas Anesthesia - Forane$ 191.00$ 463.00
5/5Surgical Assistance Team$ 150.00$ 613.00
5/5Lateralization of Lt Cartilege$ 500.00$1113.00
5/5Intravenous Catheter - Initial$ 34.15$1147.15
5/5IV Infusion Set - Initial$ 14.70$1161.85
5/530" Extension set set Init/Replace$ 5.25$1167.10
5/5Fluid Therapy IV$ 22.05$1189.15
5/5IVAC Infusion Pump/day$ 7.90$1197.05
5/5 Intensive Care/Hopital$ 32.55$1229.60
5/5 Daily Injections 1-5$ 23.10$1252.70
5/5Cefazolin 6cc-10cc$ 15.75$1268.45
5/5Cefazolin/Cefalothin$ 24.05$1292.50
5/5Acepromazine SC/IM$ 24.40$1316.90
5/6Suction, Clean, Replace-E-T Tube$ 35.00$1351.90
5/6Gas Anesthesia - Halothane$ 00.00$1351.90
5/6Oxygen$ 40.00$1391.90
5/6Tracheostomy Tube$ 0.00$1351.90
5/6Fluid Therapy IV$ 22.05$1413.95
5/6Critical Care Unit$ 37.80$1451.75
5/6Daily Injections 1-5$ 23.10$1474.85
5/6Cefazolin 6cc - 10cc$ 31.50$1506.35
5/6Acepromazine IV$ 27.15$1533.50
5/6Atropine SC/IM$ 24.40$1557.90
5/6DexamethasoneIV$ 27.15$1585.05
5/6-5/12Dr. Henry/Intensive Care$1503.00$3088.05

1998 Doris Engbertson


lablover@relaypoint.net

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