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Respiratory Problems in Dogs
Sneezing
Small foreign body in nasal passage
Chronic bronchitis
Esophageal constriction problems
Gurgling sounds when inhaling and exhaling
Sneezing
Rapid Respiration
Breathing changes in lab mix
Allergic Bronchitis or pulmonary congestion
Nasal discharge
Stenotic nares surgery and chronic upper respiratory problems
Blocked nostril in Schnauzer
Immune system deficiencies and infections
Pneumothorax
Breathing/sleeping noise
Raspy and congested
Narrow nostril openings
Fungal Pneumonia
Breathing Difficulty in Bulldog
Hoarseness
also see Coughing
also see Larynx and Throat problems
also see Allergy
also see Diaphram Problems
also see Kennel Cough
also see Paroxysmal Respiration
also see Pneumonia
also see Tracheal Problems
also see Pulmonary problems
SneezingQuestion: Hi, Dr. Mike,
We have two dogs. Holly, a cocker/lab mix and Millie, a terrier mix (looks more like a Cairn than
anything else). We've had to put the girls in day care many times over the last month due to
landscaping and construction at our house. Mille has started sneezing recently. I looked up Kennel
Cough on Vetinfo, but she really isn't coughing - no hacking, more through her nose like she has a
cold or allergies. I don't see any discharge. I noticed today that Millie is also somewhat listless and
she ignored her normal dinner dog food (Wellness Super 5 Mix because Holly is allergic to
everything). She did readily eat all of the meat from a chicken breast. Millie also had a mast cell
tumor removed last year and the prognosis was excellent. Does pneumonia start with sneezing? Is
there anything else I should take into consideration. Thanks for any information you might have.Judy
Answer: Judy-
Sneezing is not as common in dogs as it is in people in response to upper respiratory diseases, but it
does sometimes occur. When sneezing persists, we usually want to look for an underlying cause,
whenever possible. The most common underlying causes are allergies (not as commonly in dogs as in
people, though), tooth root problems, foreign objects trapped in the upper airway system, infections
of the nasal passages or sinuses, nasal passage parasites (nasal mites), nasal cancers and probably
some other things I'm not thinking of. In Mollie's case, it would be necessary to think about the
possibility of a return or spread of the mast cell tumor, but hopefully this is not the case.I can't recall a case of pneumonia in which sneezing was an early sign. It is probably safe not to
worry too much about this possibility.The only thing you can really do if the sneezing has persisted is to start to look into the possible
problems. A good physical exam, then tests like X-rays of the tooth roots and nasal passages,
examination under anesthesia for a foreign body or signs of infection or nasal parasites (it may be
necessary to have an endoscopic examination of the nose to find these), nasal flushes or other tests
might be necessary. Your vet can help you figure out the best path to take to get to a diagnosis if that
is necessary. Hopefully, Molly is better and it won't be.Mike Richards, DVM
6/5/2001
Small foreign body in the nasal passages
Question: I just subscribed to your vet info. site. I have two Golden Retrievers.
One of them just had surgery with an endoscope. We believe she got a small
woodchip up the nose. Unfortunately nothing was found in the surgery.
Sometimes I guess it is hard to find. She is still having trouble. Have you
written anything on this subject? I look forward to the site and the vet
info. digest. Thank you
Answer: Mary-
It can be really hard to find a small foreign body in the nasal passages of
dogs or cats. It is also not unusual for dogs and cats with symptoms
suggestive of a nasal foreign body to have no discernible cause when
examined endoscopically. In a study published in the AVMA Journal (Willard,
Nov 1 1999), 118 pets were examined endoscopically due to signs of nasal
passage disease and a diagnosis could only be obtained in 43 of the cases.
This is enough success to make the procedure worthwhile but it does show
that it doesn't always produce an answer to the problem.If the signs persist it may be worth trying the endoscopic examination
again or trying an alternative procedure, such as nasal flushing, to see if
the problem can be diagnosed or resolved. If these things do not help, it
can also be helpful to take good X-rays of the tooth roots to be sure they
are not infected and causing problems. If that does not help, an MRI
examination is helpful in some dogs, although it is an expensive test. A
more invasive approach would be to surgically explore the nasal cavity but
that may be a more aggressive approach than you are comfortable taking,
especially if you are really certain that the underlying problem is an
inhaled foreign body.Mike Richards, DVM
3/10/2001
Question: Dr. Richards,
This is the first question I have asked. I am a new subscriber. Thank
you for this service.
I have 12 yr. old doberman spayed female. She is in good health for her
age and breed except for bronchitis. She was diagnosed at the Uni. of
Fla. about 2 months ago although she has had a cough for about a year.
My local vet thought she had some type of respiratory problem. Her lungs
sounded clear to him and still do according to the vets at the uni. I
took her over there because nothing we tried locally helped. We tried 3
different antibiotics. I can't tell you what they were offhand.
At the uni. they xrayed her and came up with chronic bronchitis. They
say there is not cure but it is treatable with steroids. I am not in
favor of using steriods until I have to because of the side effects. She
has bad knees and some arthritis and I don't want her to gain weight.
She also has a small problem with urinary incontinence.
I was wondering if you had any other suggestions for controlling or
treating her condition other than steriods. Any help will be
appreciated. My dog means the world to me and I want to make her as
comfortable as possible. It seems that lately her cough has gotten
worse.
Thank-you, GordonAnswer: Gordon-
There are several things that may be helpful, other than corticosteroids,
but there it is hard to completely control chronic bronchitis in a dog
without the use of corticosteroids.Antibiotic therapy usually doesn't help too much with chronic bronchitis
problems in dogs, unless there has been a secondary infection from chronic
irritation of the airway. Despite this, it can be helpful to get a tracheal
wash or bronchoalveolar lavage sample for culture and examination of the
types of cells present. This may have been done at the veterinary school,
already. It is not unusual for dogs with chronic bronchitis to have normal
X-rays and normal sound lungs on auscultation.These are the things that help, other than corticosteroids, that I can
think of:1) If your dobie is overweight, that is contributing to the problem. I am
always surprised by how much benefit there is to weight loss in patients
with chronic bronchial disease and how many patients get worse as they get
heavier when weight loss isn't possible. Controlling weight will have a
major impact on the clinical signs of this disorder. Exercise might help
with weight control but it has to be started gradually, if she is not used
to it, because it can also irritate the airways. Over time, more active is
usually better than less active, though.2) Reduce environmental contaminants as much as possible, especially
cigarette smoke and low humidity environments. If it is not possible to
avoid a low humidity environment in the winter, consider using a humidifier
in a small room for a few hours a day to help with breathing, if that is
possible to arrange.3) Bronchodilators like theophylline (Theo-Dur Rx, 20mg/kg twice a day) can
be helpful. Beta-agonist medications such as terbutaline ( Brethine Rx) or
albuterol (Proventil Rx, Ventolin Rx, 0.5mg/kg every 12 hours). There are
several publised protocols for terbutaline use. The smallest tablet is
2.5mg and the starting dose should be around 1/4th of a tablet per 10 lbs
of body weight. For bigger dogs 2.5mg to 5mg every eight to twelve hours
should be sufficient, even if the "per lb." dosage seems to exceed
that. If you use theophylline, it is important to remember that it
interacts with several other medications, especially enrofloxacin (Baytril
Rx), so it is important to adjust the dosage based on the other medications
being used at the time.4) If you wish to avoid most of the side effects of corticosteroids but
still get most of the benefits, the use of corticosteroid inhalers is
potentially helpful. I have not actually seen much written about the use of
these medications in dogs but they are helpful in cats with asthma and so I
can't see why they wouldn't be helpful in bronchitis, as well. The use of
an anesthetic mask to make sure that the patient inhaled the medication
would be necessary but these are inexpensive and should work pretty well
for the purpose, even in a long nosed dog like a doberman. There is an
article on the use of these in a recent Clinics of North America chapter by
Dr. Padrid and your vet might have access to this journal.5) In many dogs it is necessary to use prednisone to gain control of the
coughing. It is often possible to use corticosteroids at a high initial
dosage for a short period of time, such as 0.5 to 1mg/kg per day for 3 to 5
days) to suppress the irritation, then switch to a low every other day
dosage quickly, limiting the side effects.I hope this helps some.
Mike Richards, DVM
3/4/2001
Esophageal constriction problems in German Shepherd
Question: Hello Doc!
I have a 2 and 1/2 year old German Shepherd male that developed breathing problems about 8 months
ago. His throat became inflamed inside and most symptoms passed after 2 weeks. Now, 8 months
later, he doesn't have much trouble breathing but cannot eat any solid food. Before we discovered the
problem, he had lost quite a bit of weight. He would try and eat but would cough the dry (mixed with
water) food out of his throat in a manner similar to someone trying to clear his throat. It does/did not
appear that the food stuck in his throat was coming back up from his stomach or intestines. After
clearing his throat, he would try to eat again and then give up after about 3 attempts.Our vet took initial x-rays and noticed a major swelling in one area of his throat/esophagus. To ensure
that my dog did not have cancer, he then (additionally) took him through more x-rays at our local cancer institute. The results confirmed that while there is no cancer, it appears that for some reason his throat area is
obstructed, and is now as narrow as the width of a pen. His inner throat/esophagus is not
symmetrical, but instead looks like the shape of a tunnel (3/4 round and 1/4 flat where the
swelling/inflammation is). He eats most of his food now because we now use can food and mix it with
water until it is virtually a soup. He does not regurgitate his food at all. If he comes across a larger
piece of food, it may still go down slow. His energy level is pretty good. He has put on more weight
now.He was training with me in Schutzhund and is going crazy because he stays home every night now.
The throat problem does not appear to have been caused by any training, and the vet has not detected
any foreign object lodged therein. I asked our vet about megaesophagus and he says that he is
familiar with the defect and does not think my dog has megaesophagus. The vet has put my dog on
antibiotics (over 3 weeks now) and it does not seem to have corrected the problem.Have you heard of this condition before? Is there a place that we can consult that might be able to
provide the best advice available for my vet? Thanks so much! MikeAnswer: Michael-
Esophageal constriction problems are not a common problem but they occur frequently enough that
the veterinary schools and larger referral centers have experience dealing with them and there is a
good deal of information in the veterinary literature on treatment options. The shape of the stricture
that you describe suggests something outside the esophagus leading to the stricture since esophageal
scarring tends to lead to a circular constriction, at least based on the literature. If your shepherd were
much younger a persistent aortic arch would seem likely but this should show up right at the time a
dog starts to eat solid food, not at 2.5 years of age. I have read of a few instances of
treacheal/esophageal fistulas forming, usually due to trauma or foreign bodies, which might be a
potential problem since this seemed to start as a respiratory problem. It is probably more likely that
there was aspiration pneumonia secondary to a problem in the esophagus, though.There are reported successes in dealing with esophageal strictures through dilation of the esophagus,
using techniques such as balloon dilation or bouginage, which is the use of progressively larger
rounded dilators to increase the size of the esophageal lumen. These seem to work longer term at
least 30% of the time and it is acceptable to treat again when strictures form again. It is possible to
replace portions of the esophagus, although this has a higher than usual instance of complications.
Since your shepherd has a reasonably good quality of life with your present approach to this
problem, this type of surgery might be riskier than is necessary.If the stricture worsens over time, or if there is a problem outside the esophagus that can't be
resolved, there are patients who do well over long time periods by implanting a feeding tube directly
into the stomach. Hopefully this will never be necessary, though.I would want to refer a patient with this sort of problem to one of the veterinary schools. I'm thinking
that isn't a very good option in your case, though. If your vet has contacts with a surgeon who has
used either the balloon dilation or bouginage technique in humans, he or she may be able to provide
enough insight and expertise for your vet to feel comfortable pursuing treatment. If this isn't an
option, your vet might be able to find useful advice through the Veterinary Information Network (tm)
or NOAH (the AVMA's internet site). There is a good description of the techniques for esophageal
dilation in "Small Animal Surgery" by Theresa Fossum, too.Good luck with this.
Mike Richards, DVM
1/29/2001
Gurgling sounds when inhaling and exhaling
Question: We have an older dog, Lucky Dog, who is about 10. He was here when we moved in. He has had
congestion for about 8 weeks now. I took him to the vet and he didn't like the looks of his red gums
and teeth so he out him on antibiotics for a week and then I took him in for the cleaning of his teeth.
The congestion never left. He out him on another antibiotic which was no help either. (He makes a
"gurgling" sound but does not cough.) The VET took an e-ray of this throat and could not
find anything wrong. His appetite has fallen off some which has never happened before, The VET
did prescribe some Benedryl and after I finished the 10 pills I purchased over the counter ones and
give him 1/2 a pill twice a day. The don't really seem to help. In the very beginning (before I took
him to the VET) I tried Vicks Formula 44 which seemed to help more than the Benedryl but as I
said, he does not cough. He just sort of "honks" and gurgles. He is outside in the daytime and
sleeps in the house at night but the weather has been mild so far this season. (We live in the San
Joaquin Valley.) Do you have any clues? How about Valley Fever? (I just thought of that.)Thank you very much,
Dixie
Answer: Dixie-
There are a lot of possible causes of gurgling sounds when dogs inhale or exhale. Laryngitis,
epiglottitis, pharyngitis, tracheitis, laryngeal paralysis, collapsing trachea, pneumonia, heart failure,
cancer of the airways and other conditions can all cause these symptoms. In your area, it does seem
like checking for coccidioidomycosis (valley fever, San Joaquin Valley fever) would be a good idea,
especially with the weight loss, as that is reported to be a common sign of this disease. If his lungs
were X-rayed in the last X-rays, there is a good chance that signs of coccidioidomycosis would
show on the films. There is a blood test for this disease which is supposed to be helpful in ruling it out
when there is not clear evidence of the problem from clinical signs, X-rays, tracheal wash or other
diagnostic procedures. Your vet will know a lot more about this disease than I do, almost for sure,
since I do not live in an area in which it occurs.If there is a chance that Lucky Dog was originally from another area it might be worth checking for
heartworm disease (that is a problem in my area so I am sensitive to it) --- but I am betting that isn't
a likely problem if he lived near your residence all his life.If you have not already taken Lucky Dog back for a re-exam, that would be a good first step. It is
sometimes a lot easier to diagnose a problem on the second or third recheck as the signs of the
disorder become more clear.Good luck with this.
Mike Richards, DVM
12/6/2000
Question: Zeus sneezes a few times a day, maybe six times. He has done this for
months.I guess the sneezing is caused by the dust in the house. Generally, the
other two do not sneeze, except Muffin (15) after having her teeth cleaned.
Presumably six sneezes a day is nothing to worry about.
Answer: Sneezing can be associated with periodontal disease, allergies, upper
airway infections, nasal mites (I have no idea if these are a problem in
England but they are in some areas of the US) and probably a few other
conditions. Most of the time, sneezing without some other evidence of
disease is not too much of a worry but it might be worth having Zeus' teeth
examined.Mike Richards, DVM
Question: Hi Dr. Mike,
I am a subscriber who wrote you about a month ago about my large mixed breed
(90 lb male 10 years old (lab, border collie, newf?) dog (Noah) who was
having rapid respirations (avg. 60 to 70 per minute; has been as high as 90
and as low as 40) but no other symptoms. At the time we thought it was
bronchitis. This has been going on for about 10 weeks. Tests have ruled out
Cushings. Low thryoid problems were found (very very low according to our
vet) and he has been put on thyroid medication but this has not done anything
to help respirations. Please note, he is not panting. These rapid
respirations occur whether awake or asleep with mouth closed. He can't
tolerate exercise and gets tired very easily.Any information or thoughts you could give would be very much
appreciated.Thank you. Brenda
Answer: There are a lot of problems that can lead to rapid respiratory rates. Upper
airway disorders such as nostrils that are too narrow, obstructions in the
nasal cavity, pharyngeal disorders, laryngeal paralysis, tracheal collapse
and tracheal parasites can cause rapid respiratory rates. Lower airway
disorders such as bronchial constrictions (allergic, asthmatic, etc) can
also do this. Heart and circulatory disorders such as heartworms, anemia
and bleeding disorders can lead to increased respiratory rates. Injuries to
the chest, ribs, sternum (including congenital defects) or the abdominal
cavity which cause pain or bleeding can lead to increased respiratory
rates. Things that cause fluid to accumulate in the chest cavity (cancer,
heart disease, heartworms) can raise respiratory rates. I think that pain
alone can do this and that stress probably can. Infections such as
pneumonia, septicemia and probably osteomyelitis can do this. At this
time, many of these problems have probably been ruled out --- but if one of
them seems possible to you, it would be a good idea to ask your vet about it.I hope this helps in thinking over the possible problems.
Mike Richards, DVM
9/10/2000
Breathing changes in lab mixQuestion: Dear Dr. Richards - I have a 10 year old mixed breed (possibly lab, border
collie, +??) 90 lbs, male, deep chested and short legged who has been in
good health except for a pancreas problem for which we watch his diet very
closely. He has some minor arthritis and takes 1000mg
Glocosamine/Chondroitin in the morning and 500mg at night. This has helped
him tremendously. About 9 days ago we noticed a change in his breathing
pattern. His respirations were 78 but he otherwise seemed ok - good appetite,
bright eyes, etc. We took him to the vet and she diagnosed bronchitis after
checking his heart, lungs, etc. The diagnosis was based on x-rays. She put
him on Baytril 1 1/2 tabs twice a day. After 2 days of taking the medication
with no change she added Theophylline 100mg 2xdaily. It has now been a week
and there is no real change in his respirations which are ranging 60-70 per
minute. He has tested free of heartworm and is on heartworm medication. On
Thursday he will be re- x rayed to see if there is change. Could we be
missing anything? I am concerned that there has been no change. A friend
suggested we look into a fungus as the source problem but I don't know. Any
help or suggestions you might have would very much be appreciated. Thank
you. BrendaAnswer: Brenda-
Labrador retrievers are prone to laryngeal paralysis, which can lead to
significant alterations in their breathing rates or breathing patterns. It
would be a good idea to consider this in an examination. Some of the
hormonal diseases can cause increases in respiratory rates, most notably
hyperadrenocorticism (Cushing's disease) and hypothyroidism, although we
don't see increases in respiratory rates very commonly with hypothyroidism.
Anemia can lead to increases in respiratory rate and we see this most
commonly with hemangiosarcoma tumors in dogs in this age range. Allergic
bronchitis may not respond to antibiotics or to theophylline, so it is a
cause of bronchitis that has to be kept in mind, if the X-rays continue to
be suggestive of a bronchial problem. A tracheal wash might help in
determining if this problem is present. Tracheal collapse is unusual in big
dogs but does sometimes occur. It usually causes coughing rather than
increases in respiratory rates but once in a while it can cause panting or
rapid shallow breathing. Pneumonia, including fungal pneumonia, is
definitely possible but should show up on X-rays when it is severe enough
to affect respiratory rates. Pain can cause increases in respiratory rate
so it is always a good idea to try to be sure there is no source of pain or
that a chronic problem that has been responding to pain control hasn't
gotten worse. Often this is evaluation is subjective and you just have to
make a guess about whether pain is increased. Heart disease other than
heartworms is possible but usually will have some X-ray signs, such as
heart enlargement or pulmonary edema which might show up on this next set
of X-rays. Cancer is also possible and also usually shows up on X-rays when
it is affecting the lungs (but might not if it is affecting the heart,
causing anemia or leading to respiratory signs through some other cause).These are the things I can think of. Rechecking and taking X-rays again is
a good idea. If there is any question about the findings on the films, it
is usually possible to arrange for a radiologist to review them. This is
often standard procedure in human medicine but usually has to be requested
in veterinary medicine.There are enough causes of changes in respiratory rates that it may take
several office visits and several different lab tests to finally localize
the problem.Hope this helps some.
Mike Richards, DVM
7/9/2000
Allergic Bronchitis or pulmonary congestion possible in French bulldog
I talked to the vet early Thursday and just happened to mention that
Cowboy's biggest problem was the pain he felt when swallowing. I took
him in to see the vet who examined the neck and throat and
then put him on oxygen for a while...no change. On a hunch he then
gave the dog an antiinflammatory injection. Lo and behold, Cowboy became
calmer, relaxed and went to sleep. As it turned out, he had a very sore
neck from a rough playtime and I never knew. He has been on Rimadyl
since Thursday afternoon and seems to be his old self again. Still has
his allergies but we will watch that till the neck calms down.(We will
not keep him on Rimadyl forever...just 14 days.)Thanks again..maybe this input will help someone else in the future!!
Jean
Question:
(All the symptoms etc. are very new to him..none of this has happened
before.)
Thanks so much for your prompt reply. Your input really helped.His heart was normal on the x-ray...the ultrasound may be a near- future
option...I am familiar with such examinations. Little Cowboy is feeling
a little better right now. We are leaning toward an allergy-related
situation....Benadryl 25 mg. quieted him down this afternoon..his
"rattling" seems a bit improved..I should say that this is a little dog with giant heart. He was very
sick before he allowed it to change his routine and thus show elevated
symptoms.. Maybe that''s how the allergies got out of hand.I am very familiar with the great job vet schools do...thanks.
Just a thought...we have lots of deer here. Cowboy is fascinated by the
taste of deer droppings. Is there a chance he could have picked up a
bug from that, or vestiges of another wild animal that has roamed in
our mountain area? On our walks, he does lots of intense sniffing.Thanks again,
Jean
Answer: Jean-
I am not aware of any diseases that are transmitted to dogs from deer by
eating their stools. It is probably possible that some bacterial pathogens
could be passed in this manner. The major disease that we worry about with
deer is Lyme disease but that is transmitted by the ticks that also infest
the deer, not directly through contact with stools.Unfortunately, I can't be sure at all that just because I haven't heard of
a disease problem transmitted in this manner that there isn't one.I hope that Cowboy continues to improve. We have a couple of patients with
allergic bronchitis. This is a condition that can usually be controlled
reasonably well but isn't very likely to be cured. It often takes several
treatment efforts to find the one that suits a particular patient best, so
keep working with your vet on this.Mike Richards, DVM
6/20/2000
Question : My French bulldog seemed to get sick suddenly last week.
Lethargic, slow on his walk, then shivering. It has been very dry here, and I
have felt like he had allergies related to dryness, etc. They did not seem
severe enough to get concerned. Last week then I took him to his vet who did
blood work, x-rays, endoscope. His lungs are very congested.
His blood work is normal..no elevated white count. He seems very
sore..
Seems to hurt to pick him up.This little dog has never been sick in his 5 1/2 years. No elongated
soft palate, his nose opening was widened early on. Very slight
evidence of collapsed trachea..vet says not serious enoough to cause
such congestion. I asked prognosis and he said "guarded".He has been taking amoxicillin, 200 mg. 2x a day, albuterol
sulfate 1/4 of 2 mg. tab 2x a day, and 1/4 of 10 mg torbutrol 2x a day. He .seemed
to be doing better and was taken off the torbutrol today to start
Theo-Dur 300 mg. 2x a day tomorrow. I have a strange feeling about
Theo-Dur...can't explain. My pharmacist said it seemed kinda strong to
him for a little dog like Cowboy.(He weighs 32 lb.) Just a little while ago he had a reverse sneezing
episode that scared us. He hunched up, moved around, became glassy
eyed. I felt he was in pain. I gave him the torbutrol and after a
while he relaxed and went to sleep. (Was very thirsty and wanted ice.)The vet won't, or can't, say what is wrong, except that there is
nothing anatomically wrong with him. What do you think? Are we doing the
right thing? I know to expect respiratory problems with bulldogs...but not so
suddenly and so severely, esp. in a seemingly healthy animal. Hope you
can help. I feel his little life is hanging in the balance!Thanks so much,
Jean
Answer: Jean-
It is likely that your veterinarian has been considering the
possibility of heart problems as a potential cause for the congestion in the lungs
but you didn't list ECG or cardiac ultrasound examination among the tests,
so it seems like a good idea to point out this possibility. I don't know
of any specific heart problems in French bulldogs but individuals of any
breed can develop heart related problems.Allergic bronchitis can lead to pulmonary congestion when it is
severe but that is often possible to detect with bronchoscopy and cytology
(which was probably done during the endoscopy). Controlling this can
sometimes only be accomplished by using corticosteroids but that is a problem if
there is fear of an infectious cause.Upper airway problems can lead to pulmonary congestion but it
doesn't sound like that is a problem. Cancer is always a concern in
non-responsive lung diseases but also is probably not highly likely.We don't use Theodur (Rx) much, but only because I haven't felt
like it did a lot for the patients we have tried it on. We have had a little
nervousness in one patient while using this medication but no
significant side effects other than this, that I can remember. So I tend to
think it is reasonably safe but am not convinced it is all that
effective. That's just my personal opinion, though. Lots of vets do use Theodur and think
that it helps.We see dogs that are afraid to be picked up when they pulmonary
congestion from either lung disease or heart disease. I think that the pressure on
their circulation from being picked up makes them uncomfortable or is
frightening. Again, this is my personal theory, not something I
know to be fact.I would recommend asking for referral to a veterinary college or
referral center for a second opinion. When dealing with a disease or
disorder that isn't responding well to treatment and that seems as if it might be
life threatening, getting a second opinion is important. Your vet has
done a good job so it seems like it would be best to get a second opinion
from a place with multiple specialists who can confer. This would be
especially true if the condition is not heart related. Pulmonary congestion
that isn't from a heart problem and isn't responding well to standard
treatments is a difficult problem.It is important to continue to seek a solution to this problem,
whether you choose to work with your vet or to seek help through referral to a
veterinary college or large referral center.Mike Richards, DVM
6/16//2000
Question: Dear Dr. Mike,
Buddy has an occasional discharge from his nostrils. I first
noticed it many months ago, but since it is not going to happen when
I bring him to my vet to have a look, and since he seems in good
health, I have been unsure as to how to handle this. The discharge
looks like milk, pure white and liquid, and it accumulates at the
lower outside of the nostrils. There is not enough for it to run,
just enough to gather. .Have you ever come across anything like this? Is it possible
that it is *not* an indication of something horribly wrong? What
things might it be, either not worrisome or worrisome? Is there
something I ought to do about investigating this?Thanks very much.
Best regards, Helen
p.s. I have a digital camera, and could try to catch it the next
time it happens, if you feel that would be helpful.
Answer: Helen-
I would want to look at a smear of the exudate from the nostrils if Buddy was
a patient of mine. This sort of exudate may be associated with irritation
from allergies or it may indicate an infection of the nasal passages. If
there is an infection it is sometimes possible to tell that from a smear of
the exudate by looking for bacteria or fungal elements. The only problem with
this is that the exudate has to be pretty fresh when the smear is made, so
you would have to collect some on a cotton tipped swab and make a quick trip
to the vet or you would have to bring home a glass slide from the vet's and
make a smear by collecting some of the exudate on a cotton tipped swab and
rolling the swab along the slide. We have been able to get good slides from a
couple of clients whose pets had intermittent problems like this by letting
them make the slide.There is also a good chance that examination of the exudate won't be helpful.
Lots of times there is just mucous or white blood cells and mucous but no
visible infectious agent. In those cases you have to make a decision as to
how important it is to know what is going on. Since Buddy feels OK and the
problem is intermittent, there is good reason to lean towards just monitoring
the situation and then treating if it gets worse. The other way to go is exam
of the nasal passages, which usually means finding someone with an endoscope
small enough to fit into the nasal passages. We refer these cases to the vet
schools.Ask your vet if there is a way to help him get a look at the exudate and then
decide what the next step is based on what you find. If you can take a
picture of what Buddy's nose looks like when the exudate is there and show it to your
vet's it might help in explaining what is going on. I'd think that one taken
with a digital camera and printed out would work.Mike Richards, DVM
2/28/2000
Stenotic nares surgery and chronic upper respiratory problems
Question: Hi Dr. Mike! This is my first question (officially) and just to warn you,
you will get many more. I am the Director of Alabama Pug Rescue and
Adoption, Inc. I cater primarily to the special needs Pugs and own 7 of my
many rescues myself to include a spectrum of cerebellar hypoplasia,
epilepsy, deafness, and massive allergies. The reason that I am writing you
this time is "Dolly" a three-year old beautiful girl who was sent to me last
spring from Minnesota.Dolly's initial needs were surgery for spay and hernia repair. She also had
a cilia problem and scarring in one eye and subsequent surgery followed. My
vet also recommended that we do stenotic nares surgery at the time of her
spay, which we did, and was a failure. He had done this procedure before,
but stated that there was so much tissue that he could not adequately open
her up for significant relief. She does have decreased stamina, although
she is not really a significant snorer like many of these other
brachycephalic babes.In September of this year Dolly came down with a case of tracheobronchitis
which carried on for three weeks and was then treated with two different
rounds of antibiotics. When there was no significant improvement, an x-ray
was performed which showed a questionable enlarged heart, collapsed trachea
and lung involvement. We were referred to a specialist in internal
medicine. Findings were that the heart appeared normal, however the trachea
was indeed collapsed at the portion closest to her lungs and that part of
one lung was also collapsed. Treatment was started with Theophylline 200 mg
twice daily and Prednisone. After three weeks there was some improvement,
but when weaning off of the Pred the coughing began to flare again. She was
put on another short term dose of Prednisone, and this time there was some
improvement. A second x-ray showed improvement in the trachea but no change
in the lung. The internist has suggested tracheal washing to obtain lung
tissue if this problem persists, but has warned me that because of the
condition of her lungs she is very high risk.We have noticed with Dolly that before she has a flare up she has a foul
odor that comes from her nose and/or mouth. Her teeth are in excellenent
shape. This is a usual sign that we are getting into trouble, and this
happened again recently and her primary vet reinstituted antiobiotics.
Dolly sleeps with us, and when she sleeps, she sleeps hard, but when she
wakes it almost like she panics. She rubs her face almost as if she is
having an allergy attack, however she shows no other allergy symptoms (I
currently give two rescues shots, so am familiar with the tell-tale allergy
signs). She also appears to have some swelling under her eyes. She will
blow significant moisture from her nose as well. I don't know if this is
related to this underlying problem, but it does seem to all tie in together.
She is now off antibiotics, and is being maintained on her Theophylline. It
seems as though she has gotten herself into a repeating cycle, and I am
afraid to go through with the tracheal washing, but I am also as afraid of
what may happen if I don't.Any advice would be very much appreciated.
I am also looking for all information I can find on cerebellar hypoplasia,
or anyone who specializes in this problem in dogs. When you have time (I
can imagine you have little) please read about my Hope at
www.rescuepug.com/Alabama. I will promise to approach you with her at a
much later date, in the meantime I am trying to understand all I can about
her.Your service is incredible and I am so glad that I finally am a subscriber.
Thank you in advance.
Pam Mayes
Alabama Pug Rescue and Adoption, Inc.
www.rescuepug.com/Alabama
Answer: Pam-
It isn't too unusual for stenotic nares surgery done on the external nares
opening to only provide partial relief. There are often other anatomic
problems in the internal nares and/or the soft palate region that prevent a
total resolution of the clinical signs. In severe cases it can help to do
surgical correction of the soft palate abnormalities but this is a surgery
that is best left to a surgical specialist with experience in this type of
surgery, due to the high potential for complications when doing surgery in
the pharyngeal and palate regions. There is some evidence to suggest that
early intervention to provide adequate airway flow does help prevent the
development of secondary problems like tracheal collapse and chronic
bronchitis.Tracheal washes can be very helpful in identifying the type of bacteria
involved in infections in the trachea and bronchi. This can also be a
source of confusion, since bacteria are normal inhabitants of the airways
in small numbers, so finding a bacteria that might be pathogenic does not
necessarily confirm that it is currently causing infection in a particular
patient. Sometimes, though, the bacterial culture clearly identifies a
bacteria that shouldn't be there or that is very likely to be causing the
clinical signs of chronic bronchitis/tracheitis to worsen.If there is some other complicating factor, such as a fungal infection or
cancer it is often possible to determine this from a tracheal wash.
Inflammatory cells present can sometimes give a clue as to the cause of
inflammation in the trachea.This is a hard situation to figure out the best approach to. Ideally,
patients with upper airway obstructions of any kind would be evaluated
under anesthesia to see if they have a condition that can be surgically
corrected. This provides the best long term solution to their problems and
it helps to keep other airway problems from developing into severe problems
themselves. If secondary problems like collapsing trachea are suspected,
then tracheoscopy and bronchoscopy with bacterial culture and cytologic
examination are the next steps to take in an ideal situation.Unfortunately, patients with upper airway obstructions and secondary
changes associated with them are poor anesthetic risks compared to the
general population. This makes it a little scary to do the type of testing
and possibly surgical corrections, that are the most benefit.Our solution to this problem has been to refer patients we suspect need
upper airway examination and possibly correction to facilities that have
both an anesthesia specialist and surgical specialists. We usually use the
veterinary schools close to us because they also have an additional benefit
--- lots of veterinary students to provide around the clock monitoring
post-surgically. This isn't a perfect solution since our clients have to
travel several hundred miles but we have been lucky so far and haven't had
a patient have severe complications that I can remember.There is a chapter on managing chronic bronchitis and a chapter on tracheal
collapse in the new Kirk's Current Therapy XIII book. Your vet might have
this book. The mainstay of control of these problems is corticosteroid
administration at the lowest possible doses that control the problem and
the use of antibiotics and cough suppressants on an "as needed" basis as
supplements. Usually it is necessary to control the problem long term since
a cure is not likely after symptoms are present.I couldn't find any references to cerebellar hypoplasia in pugs on an
initial literature search but did find reference to this problem in a
couple of other breeds (Gordon setters and Kerry blue terriers). I will
search through the textbooks at the office to see if I can find anything else.Mike Richards, DVM
12/14/99
Q: Hello Doc, you there?
I appreciated the very quick response to my last (which was my first)
e-mail.
I told the Schnauzer story and the Exxon the cat story. All Exxon's tests
came back negative, the vet put him on Vibramycn and he seems to be feeling
like his old self again.On to my question...
My schnauzer, Cyndi, who has the medical history of heart murmur and chronic
active hepatitis.. I noticed her right eye (the white part) is very red. I
also noticed that her right nostril seems to be stopped up. If you cover
her left nostril you can here her trying to breathe through the right. If
you cover the right nostril you don't hear her breathing. She also seems to
be breathing more through her mouth than you would expect. Her temp is
102.4 and she seems to feel o.k. and is eating fine. I am probably going to take
her to the vet in the morning however it is a relief vet as my regular vet
is out of town.. relief vet of course is not familiar with Cyndi and with her
on-going medical conditions this concerns me.Do dogs get sinus infections or could this be something going on, could her
heart or hepatitis be causing someting else to happen. She is on medication
daily for heart murmur. She was on Flagyl for two months...vet checking
blood values on a regular basis. Took her off the Flagyl until next blood
test to see if there was any change. She has been off of the Flagyl for
about three weeks. Dog is 13 y.o., spayed female.Any ideas - could sinus infection be a possibility or should I prepare
myself for something else?What is a dogs normal temp...102?
Thank you, Tina
A: Tina-
Dogs do get sinus infections and other upper airway problems similar to
those experienced by humans. I think that we would be a lot more aware of
the frequency of these types of problems if pets could talk.You do have to be concerned about the possibility of other, more serious
problems, in Cyndi's case, though.Many older dogs have periodontal disease. This can lead to inflammation of
the tissues around one eye and infection of the nasal passages on one side
only. It can be difficult to confirm this as the cause of problems, even
with clear evidence that periodontal disease is present. It is best in most
cases to treat any obvious problems of the upper teeth when symptoms such
as those you have reported are occurring.Older dogs with drainage or blockage involving only one nostril may have
cancer that involves only one side of the nasal passages or that is
affecting the area around the nasal passages and the eye (the retrobulbar
area). This is probably a little less common than teeth problems but has to
be considered in a dog of Cyndi's age.Once in a while we find a foreign body, such as a blade of grass or a small
stick that is stuck in a nasal passage. It is possible to see these with an
otoscope used to view the nostril, in some cases. In others it is necessary
to consider an examination under anesthesia. This is the least likely of
the problems I can think of, though.Liver problems can lead to reddness of the scleras (the white portion of
the eyes) but isn't likely to cause inflammation of one side of the nasal
passages only.It is a good idea to have Cyndi examined by the vet. For this type of
problem it is not quite as important to be fully aware of the medical
history as for problems that might involve her liver or heart. I think the
relief vet will be able to help.Good luck with this.
Oh --- the average temperature for dogs is 101.5 degrees Fahrenheit. We
consider anything +/- 1.5 degrees to fall within the normal range -- so we
don't get excited about temperatures from 100.0 degrees to 103.0 degrees in
our office unless there are other supporting signs of illness.Mike Richards, DVM
8/7/99
Immune system deficiencies and infections
Q: Well, Oliver no longer has psuedomonas but he has another respiratory
infection caused by Enterobacter!!! I took him in for another endoscope
and that is what they have found. His bronchi was very inflammed and
they found a significant growth of this stuff. I realize it is a
bacteria from the "gut" but can grow in soil, fresh water etc. What is
the likely origin of it in his case - fresh water? soil? (we live right
off of Lake Michigan in Chicago).Could his immune system be weak? I asked the vet before and they gave
me vitamins for him. I think I should ask them to check his various
levels to find out what he is missing. The Specialist said that he may
be lacking a sufficient amount of the requisite antibody that prevents
trachial infections.Can a dog's immune system get a boost and then be o.k. (e.g., give him
shots of something for a while)? The breeder is very perplexed by
Ollie's misfortune and finds it hard to believe that his immune system
is "bad." Could it be that he had an infection early on (e.g.,
psuedomonas) that has either suppressed his system or stunted its full
development?Sorry to reach out again but it seems to never end. Also, we now have a
two year old Vizsla and I am concerned about protecting all involved.
Thanks.
A: Suzanne-
I am having a great deal of difficulty finding much information on
Enterobacter species infections. The sensitivity test that usually
accompanies bacterial culture will help in choosing an antibiotic so at
least deciding on treatment options should be straightforward. I will
continue to try to research this and see if I can give you more information
later.Immune system deficiencies do occur and it is entirely possible that this
is a factor in the problems that Oliver is having. These can be very
individualized problems and may be genetic but often seem to occur after
severe infections based on the number of times that people notice that pets
(and humans)just don't seem to ever recover fully after some infections. It
can be very hard to definitively establish that an immune deficiency
exists. In humans there are immune deficiencies that only occur in one
family or in one area of the country or the world. It is often very costly
to establish that these problems exist. In dogs it is rare that there is
recognition of the possibility and enough available money to prove or
disprove the existence of an immune system deficiency. In some cases of
lung disease the immune system is inhibited by cilia that do not work
properly or improper formation of the mucous lining of the bronchi and
bronchioles.It is probably more common for an underlying cause such as allergies to be
the reason that infections recur easily. Organisms that normally can't
manage to overcome the body's defenses and live in the respiratory system
gain a foothold in tissue inflamed from allergies and then multiply and
cause problems themselves. It is sometimes necessary to treat chronically
for allergies and then to also treat infections as they occur.Sorry I can't be more help.
Mike Richards, DVM
Pneumothorax refers to air accumulation in the chest cavity. As odd as this sounds, the chest cavity must have a vacumn (no air) to work properly. There should be no air pressure outside the lungs. This enables them to inflate when the muscle of the chest are relaxed and it expands. The air is then forced out of the chest by contraction of the muscle of the chest. When the lung is damaged and leaks air, it collapses the lung. The same thing happens when there is a hole in the chest allowing air in. Either situation can be the cause of pneumothorax after a traumatic even like being hit by a car. If there is only a small amount of air accumulated it can be reabsorbed. This is commonly the case with blunt trauma in which the lung ruptures, then heals itself quickly. If there is a lot of air or continuous leakage of air, it is usually necessary to place a drain in the chest to remove the air and maintain a vacumn. There are several ways of doing this to ensure continuous evacuation of air. We use a Heimlich valve (same guy as the Heimlich maneuver, I'm sure) attached to a silicon tube in the chest.
Mike Richards, DVM
Q: Dr. Mike- Hello. I am writing with a question about my dog's breathing/sleeping habits. He is a 1 1/2 year old spaniel mix and on three different occasions in the night I have woken up because he has made a funny choking noise -- when I check on him he doesn't seem to be breathing. It takes me a minute to shake him awake (he is a deadweight), but when he comes around he always seems fine and looks at my like I'm nuts. I am wondering if this is at all normal or could he have some sort of doggie sleep apena (sp?). He isn't on any medication except for when he has to go on long car trips. He is afraid of the car so we give him a mild tranquilizer perscribed by our vet. Should he get some neurological tests done? I'd appreciate any advice you might have. Thanks. N.
A: My first suspicion would be that this is some variation of snoring. Some spaniels snore so loud that it is startling to hear them at first. It is possible that there could be some upper airway obstruction, a soft palate problem (elongation or perhaps a cleft palate that has gone unnoticed). It would be worth asking your vet about this on your next visit or even to schedule a visit if the problem persists. It can't hurt to check around the pharynx and upper airways for problems.
Mike Richards, DVM
Q: We have recently acquired a female chow. She is of the smooth coat type, with a "heavy head". She is quite a beautiful dog, so I hope you can help me with this. The chow sounds constantly congested. She snorts and snores, and her normal breathing is generally raspy. Is this common for this type of dog or is there something we can do. I recently moved here and have not established a vet in the the area, how ever I have taken her to several breeders to see if they recognized the "noises", all to no avail. Thank You Very Much. R.
A: If there are heavy facial folds there may be some respiratory problems associated with them. Also, check to be sure her nares (nostrils) do not close shut when she inhales. This is more of a problem in smaller short nosed breeds like Boston terriers but it conceivably could happen in a chow. If so, it is usually possible to widen the opening surgically with pretty good cosmetic effects. She could have an infection or nasal obstruction for some other reason. Soft-palate elongation problems seem possible with the chow's conformation, too. It would be best to find a new vet and get an opinion on this condition. Most respiratory problems are a lot easier to treat early than they are to treat after secondary changes in the respiratory system occur.
Mike Richards, DVM
Q: Dr. Mike I have a 7 month old pug who is happy, eating well and growing normally. When she exercises to the point of breathing heavily she has a (honking) cough and I can hear a single thudding noise in her throat each time she exhales. It sounds like flaps of skin hitting one another. Any ideas? Thank You, Judy
A: Judy- This is a guess, but I'd be most suspicious that your pug has very narrow nostril openings. When a dog that does not have adequate nostril width inhales, the nostrils are sucked shut and this can produce an audible sound similar to what you describe. In addition, this affects the rest of the respiratory tract as it attempts to apply more suction and you may be hearing a sound associated with that. If this is the problem it is amazing how much better these dogs feel after surgery to widen the nostrils. This can be done with good cosmetic results (pretty normal looking noses afterwards). This is definitely something you should discuss with your vet now, because allowing respiratory difficulties due to anatomical problems to go on chronically can lead to changes in the lungs and respiratory tract that are harmful and irreversible.
Mike Richards, DVM
Q: I have a woman friend whos' pet is suffering from fungal pneumonia. Can this lead to yeast infections in the dog and will there be a problem created in the immune system? Right now the animal is being treated with Sporenox. Any help you can be would be deeply appreciated.
A: I practice in an area in which fungal pneumonia is very rare. I am not familiar with the brand name Sporenox and will have to look it up tomorrow at my office to see if secondary yeast infections or immune problems are likely with its use.
Mike Richards, DVM
Breathing difficulty in Bulldog
Q: We have a female Bulldog who lately seems to be panting heavily and breathing very rapidly,she is three months old and is very active.What could be the reason of this and what is the best solution?
A: Bulldogs have a lot of respiratory problems related to the shape of their face and head. They can have problems ranging from nostrils that are too small and collapse shut when they breathe to overly long soft palates that interfere with their larynx. They tend to get overheated very easily. We have seen a bulldog in our practice who got heat stroke while playing in an air-conditioned house! There is also the possibility that the problems you are seeing could be related to a congenital heart defect, although many dogs with heart problems have a decrease in activity level and you are not seeing that. Even an infectious disease like pneumonia could be causing breathing difficulties, although these problems also usually cause additional signs like depression or lethargy.
Your vet can help sort through the possible problems. In the case of the anatomically related airway problems it is sometimes necessary for your vet to refer you to a specialist for a definite diagnosis and treatment. Most vets are comfortable with surgeries to increase nostril size but not many are willing to take on soft palate reconstruction if that were necessary, for instance.
The first step is to let your vet know you perceive a problem and schedule a time for him or her to examine your dog. It may be very important to her health!
Mike Richards, DVM
Q: My nine year old yorkie recently developed hoarseness which seems to have increased. She was left in my car while I went to the library on Monday and barked hysterically the whole time - about 10 minutes. Since then it sounds like somebody is squeezing her throat and today (Saturday) it seems like she isn't eating her regular (dry) food. She is acting quite the same as usual, except for the barking. I should mention that she had a seizure last week (her fourth since birth) with no ill effects afterwards. Her health otherwise is fine. Please, can you give an opinion as to why this hoarseness is getting worse? I am taking her in tomorrow but she gets extremely agitated - lips turn blue etc. when she goes to the vet - I just hate to put her through some kind of dog laryngoscopy if it is probably just caused by the barking.
PS: There is no cough associated with this and she has been eating (like usual) until today with the dry food. Thank you for your opinion!
A: There is a strong possibility is that your Yorkie has irritated a pre-existing condition such as a collapsing trachea or a bronchitis that was not quite severe enough to cause obvious clinical signs prior to the barking episode. It is not uncommon at all for older Yorkies (and older small dogs in general) to have a tendency towards tracheal collapse. If your vet finds that this is the problem after an exam, medications can help relieve the cough and control the problem. It is a good idea to get this checked out.
Mike Richards, DVM
Last edited 01/08/05