A few years ago our dog Dylan had surgery for laryngeal paralysis. Recently a few people sent me questions about this common but not well known condition, so I decided to write an updated version of a post about it that I wrote a few years ago that includes how it factored into his death in 2014.
LISTEN FOR THE HONK
Our chocolate lab Dylan was about 6-1/2 years old in 2007 when he started making a honking noise (think of what a goose honk sounds like) when he breathed heavily after running or swimming, especially in hot weather.
The sound the dog in this video makes is similar to what Dylan sounded like:
We didn’t think much of it until a woman at his day care, Dog’s Day Out, told us she noticed the noise and that it could indicate that Dylan had a breathing problem. She recommended that whenever we heard the noise we should make Dylan rest and wait several minutes before playing with him again.
This helped for a couple of months, but then his “honking” episodes began to occur more frequently and last longer so we took him to our vet to see if he could identify the problem.
Almost immediately after we described Dylan’s symptoms, he said Dylan probably had canine laryngeal paralysis.
MORE COMMON THAN YOU THINK
Have you ever heard of it? We certainly hadn’t even though it is a somewhat common condition, especially in larger dogs.
Laryngeal paralysis (LP) occurs when the muscles on either side of the cartilage covering the opening of a dog’s trachea (windpipe), begin to weaken.
When a dog inhales, these muscles contract and pull back the cartilage at the opening of a dog’s trachea. This allows air to flow into the trachea and travel to the dog’s lungs. The muscles relax when the dog exhales.
If a dog has LP, these muscles begin to weaken and cannot completely pull back the cartilage at the tracheal opening. When the dog inhales the cartilage still covering the tracheal opening is sucked down into it. The honking occurs when the air the dog inhales causes the cartilage to flap back and forth.
However, dogs with LP don’t always make a honking sound. Others just struggle to breath because their tracheal opening is partially blocked.
The weakening of muscles that pull back the cartilage is rarely static. As the muscles continue to deteriorate, the cartilage covers more and more of the trachea which makes breathing more difficult, particularly when the dog is overheated.
This can eventually lead to respiratory distress because, as the dog begins overheat, it will breathe more rapidly to compensate for the reduced flow of cool air into its lungs. As the dog breathes more quickly and forcefully, the weakened muscles that pull open the cartilage at the tracheal opening are unable to keep pace with the faster breathing and the tracheal opening is blocked more quickly.
The American College of Veterinary Surgeons notes that dogs with laryngeal paralysis are “more prone to overheating under conditions that would not make a normal dog hot. This may be a simple walk outside on a sunny day or vigorous play on a cool day.”
CAUSE OF LARYNGEAL PARALYSIS STILL UNCLEAR
Here’s the explanation from the American College of Veterinary Surgeons on what causes dog laryngeal paralysis:
I believe I caused Dylan’s LP. The woman that taught his puppy training class said to correct our dogs when we walked them by jerking their leashes. This put excessive pressure on his throat and most likely damaged the muscles that controlled his larynx.
For this reason alone, if you have a large breed dog, NEVER attach a leash to a dog’s collar. Use a harness or a gentle leader. Putting pressure on a dog’s throat can cause LP.
Jerking the leash to correct a dog is unnecessary and considered inhumane by dog trainers that use positive training methods. I’ll talk about this more in another post.
SYMPTOMS OF LARYNGEAL PARALYSIS
- The most common symptom is noisy respiration and a high-pitched sound (honking) when inhaling
- Excessive panting
- Panting when cool and calm
- Hoarse or raspy-sounding bark
- Tongue may be a darker red or purple in color
- Resistance to being touched or restrained
- Reduced activity, exercise intolerance
- Elevated rectal temperature (especially during warm weather months)
WHAT TO FOR A DOG IN RESPIRATORY DISTRESS
If your dog goes into respiratory distress, do not immediately try to load it in a car and take it to the vet.
Dogs in respiratory distress must be cooled quickly or else they can suffocate. The best thing to do is to take it to a place with air conditioning or a shady area and make it lie down. This could be difficult as your dog could begin to panic as breathing becomes harder. Be sure to remain calm so you don’t stress out your dog and make the situation worse.
If its breathing is still labored you should take it to a veterinarian or emergency animal hospital immediately to prevent it from suffocating. If it starts breathing normally you should schedule an appointment with your vet to determine what caused its respiratory distress.
YOU THINK YOUR DOG HAS LP – WHAT NEXT?
When you take your dog to your vet be sure to find out if she has had any experience with laryngeal paralysis. Some veterinarians have limited or no experience diagnosing laryngeal paralysis so they may misdiagnose it.
If your vet thinks your pet is in the initial stages of dog laryngeal paralysis but not in any immediate danger of having an episode of respiratory distress, she might give you a list of things to try that will minimize the progression of the condition such as cutting back on exercising your dog in warm weather, getting a harness instead of a collar, and cooling your dog down immediately whenever it starts to wheeze.
But if your vet diagnoses your dog with a more advanced case LP, she should refer you to a board certified surgeon who has extensive surgical experience with dog laryngeal paralysis to confirm the diagnosis.
The surgeon should tell you, based on the information provided by you and your vet and the examination of your dog, whether or not he should examine your dog under sedation.
Our surgeon told us that Dylan’s LP symptoms had advanced to the point that he wanted to set an appointment to sedate Dylan to confirm the diagnosis.
Noting that sedating dogs created stressed them both mentally and physically, he preferred to perform the surgery to tie back the cartilage immediately after he confirmed the condition while Dylan was still sedated instead of scheduling another appointment for the surgery.
WHAT HAPPENS IN SURGERY?
Here’s how it worked for us. The surgeon said he would call us immediately while Dylan was sedated after he determined whether or not he had LP. If he confirmed Dylan had LP that warranted surgery, he would ask us on the call to give him permission to keep Dylan sedated and perform the surgery.
The most common and most effective treatment for LP is Unilateral Cricoarytenoid Lateralization or “Tieback” surgery.
For a tieback, the surgeon makes an incision in the side of the dog’s neck and uses sutures to tie back the cartilage on one side of the tracheal opening far enough to allow the dog to breathe normally and prevent respiratory distress. The cartilage isn’t pulled open completely so food and fluids can’t easily enter the trachea and go into the dog’s lungs.
The surgery lasts a couple of hours, and usually the dog is kept overnight for observation.
PROPER POST-OP CARE IS CRITICAL
The vet told us Dylan’s recovery would be about six weeks. Here are the post-operative orders he gave us:
1. For the first week, Dylan could not do any walking (except to go to the bathroom outside) because it would put pressure on both the external and internal sutures and possibly pull them out. To prevent this the surgeon told us to keep him in his kennel to restrict his mobility.
We tried this for about 24 hours, but we ended up creating a small area in the basement for him to lie down in because we wanted easier access to pet and comfort him.
2. For the first 3 weeks, Dylan couldn’t do anything that could pull out the sutures. This included walking up stairs, getting up on furniture, and barking. Keeping him off stairs and furniture was easy. We just kept him in the basement and blocked access to them.
Preventing him from barking was a little trickier since he barked like crazy whenever someone knocked at the door. We solved the problem by putting a sign at the bottom of the stairs to our front door telling people to call us instead of knocking on our door, and that worked out fine.
3. For six weeks we couldn’t take Dylan on walks or allow him to take part in any physical activity.
4. Dylan could only eat and drink from elevated bowls to prevent him from inhaling food and/or water into his lungs. In a normal dog, cartilage covers the to tracheal opening to keep food and water out of the lungs, but the tieback surgery created a permanent space in the tracheal opening where it could get through.
5. Dylan could only eat and drink in very small quantities to prevent vomiting or choking which could also push food or water into his lungs.
We followed the post-op protocol and Dylan’s recovery went well. We both work from home so at least one person was with him 24/7. I realize this isn’t possible for most people. If your dog has LP surgery and no one is home all day you will probably need to get a dog sitter to at least check on it and take it out for bathroom breaks during the day.
We also slept in the basement with him so we would know if he needed anything during the night.
BIGGEST POST-OP DANGER: ASPIRATION PNEUMONIA
The biggest danger after surgery was aspiration pneumonia, an inflammation of the lung caused when a dog inhales a foreign substance. Although the vast majority of dogs recover from tieback surgery with no complications, aspiration pneumonia is the most common reason for postsurgical complications and/or fatalities.
Symptoms of aspiration pneumonia include:
- Rapid breathing
- Heart rate
- Blue tint to mucous membranes
- Nasal discharge
- Loss of appetite
- Aversion to exercise
Aspiration pneumonia can be treated with antibiotics if caught soon enough, so early detection is critical. Some people take their dog’s temperature regularly after surgery to check for fever, but you should also watch for any of the other symptoms. Fortunately Dylan didn’t develop aspiration pneumonia after his surgery.
Another potential result of the operation is that your dog could lose its bark as the surgery can damage its vocal chords. This didn’t happen to Dylan.
Your dog could also develop a seroma, which is a collection of fluid that forms around an incision. This shouldn’t be a problem, but if it gets too large, your surgeon may want to drain it.
Dylan developed one about the size of a golf ball. The surgeon told us to put a warm, wet washcloth on it for about 15 minutes 2-3 times a day. It disappeared after a couple of days.
POST SURGERY ACTIVITY
After your dog recovers from surgery, you must remember that your its tracheal opening will always be partially open, so you must constantly guard against the danger of aspiration pneumonia.
Opinions vary regarding the best way to do this.
Some people say that they don’t allow their dog to do anything that could cause LP post surgery. This includes swimming/playing in water because dogs can inhale it inadvertently into their lungs. It could also have bacteria that could infect the lungs.
Eating grass is prohibited as well because a dog could also inhale it into its lungs.
Some people continue to feed their dog by hand and only allow them to drink small amounts of water. They may also stop feeding their dog kibble or dry treats because their dog could inhale the dust/crumbs into its lungs.
Our vet told us that dog owners had to decide what they felt comfortable allowing their dog to do during its recovery. He also noted that the chances of getting LP from swimming or eating grass was extremely low. He wasn’t concerned about feeding Dylan kibble either and as long as we soaked it in water beforehand.
The only things he said we should do were to put Dylan’s food and water in elevated bowls and to NEVER allow him to wear a collar, even around the house, because any pressure on his neck could rip the sutures holding back the cartilage at the tracheal opening.
We replaced his collar with a harness and bought elevated bowls. We continued to feed him kibble mixed with wet food in warm water.
WE CAVE ON SWIMMING
We struggled with whether or not we should allow Dylan to swim again. He was a lab, so of course his favorite activity was swim after a tennis ball.
We tried to prohibit swimming, but that rule didn’t last long once we saw the shock and horror in his face whenever we passed water without throwing his ball in it.
We started out throwing the ball into shallow water so he didn’t have to swim, but he quickly caught on and started swimming on his own. A few days after that, he was flying off the bank or dock into the water just like always.
He continued to swim with no problems for 6-1/2 more years.
LP TAKES MY DOG
Dylan had no health problems related to LP until Thanksgiving 2013 when he contracted aspiration pneumonia while we were on Orcas Island.
We quickly knew he was sick as his behavior changed significantly over the course of a few hours. Initially he was listless and lethargic. We had to help him up on the couch, and that’s where he stayed all day. Then he refused to eat anything. He even turned up his nose at his favorite treats.
The next day we took him to the Island’s only veterinarian who quickly diagnosed him with aspiration pneumonia. He gave Dylan a massive dog of penicillin and gave us strict orders to keep him quiet until he recovered.
Dylan took a couple of weeks to fully recover, but in the spring he contracted aspiration again. This time he took much longer to recover, and during that time he lost a lot of muscle mass, especially in his hind legs.
He recovered after several weeks, but by then his legs were so weak he couldn’t climb the 45 stairs to our house. He started hydrotherapy to help strengthen his legs, and it appeared to help, but we had to stop it when he got aspiration pneumonia for the third time in late September.
This time he couldn’t recover. Three bouts of aspiration pneumonia within a year was too much for a senior dog. After spending a few days at the emergency vet and refusing to eat or drink anything, he made it clear to us he was ready to go.
We had him euthanized at home on October 1, 2014.
Dylan lived about 7 years after LP surgery. His case was a bit different because it’s more common in older dogs. As I said earlier, I’m convinced he contracted it when he was only 6 because of the excessive pressure I put on his throat muscles when I corrected him during walks.
I have no regrets Dylan died from a condition most likely caused by the surgery that corrected his LP. It allowed him to have a normal life for about 7 years, and without it he would have died much sooner.
People who have older dogs with LP have a tougher decision. They have to determine whether or not the extra time their dog could have is worth putting it through the trauma of and recovery from major surgery. Some are able to keep their dogs comfortable without surgery by restricting their exercise, especially in hot weather.
SEEK OUT INFORMATION, CONFER WITH YOUR VET
If your dog is diagnosed with LP and you have to decide whether or not to approve surgery to correct it, get as much information as possible so you can make an informed decision.
The most helpful resource I found was this Yahoo group for owners of dogs with LP. These people will happily answer any of your questions or concerns, share stories of their dogs’ surgeries, and clarify what you should expect. The group also has an extensive collection of information regarding LP that you can peruse. You must join Yahoo (it’s free) to have access to the group.
The best thing the group did for me was provide access to a community of people whose dogs were diagnosed with LP and reassure me that the vast majority of LP surgeries are successful with no complications.
You will also find people who strongly recommend against surgery or say you should never allow your dog in the water again after surgery. These are legitimate points of view, and you just have to decide what will work best for you and your dog.
While I hope this information is helpful regarding dog laryngeal paralysis, I prefer that your dog has a happy and healthy life with no LP.