Subscriber Area (members only)
Zoonotic disease
Becoming A Veterinarian
Becoming A Veterinarian and other stuff
Other
Veterinary Issues
Your Turn
Search vetinfo4dogs
Help
Support Vetinfo, vetinfo4dogs
and vetinfo4cats and make a donation
Trachea Problems
Endotracheal tube irritation causing coughing
Collapsed trachea - teeth need cleaning
Bronchoscopy to check cough with tracheal collapse
Hypoplastic trachea or Collapsing trachea in Sheltie
Tracheal Collapse
Tracheal collapse and paroxysmal respiration, or reverse sneezing
Tracheal irritation from trying to leash train
Tracheal collapse and Butorphanol (Torbutrol Rx)
Tracheal Wash
Tracheal collapse in pug
Tracheal collapse possible
Tracheal wash necessary
Tracheal Disease
Collapsing Trachea in Schipperke
Tracheal collapse in Pom
also see Larynx or throat problems
also see Respiratory Problems
also see Dental
Coughing due to endotracheal tube irritationQuestion: Dr. Richards,
Desiree' had her spay and dental work done the other day. I had
planned on taking her home the same day but was told she was too groggy to go
home. Instead, the vet took her home to monitor the situation.Yesterday morning the vet called to update me on her condition. She
was well enough to go home. She was eating. And a quick physical exam
indicated she was just fine. But I was also cautioned that she was
constantly coughing. Aspiration was all but ruled out and they think
she has a very irritated trachea.Aside from near constant coughing which sounds congested, her breathing
seems to be a little labored. I was told to watch her appetite and
demeanor during the week-end and if deterioration or no improvement of
her condition, to bring her back Monday for X-rays.I have to wonder if this type of problem is uncommon and how many days
should one allow before looking for other problems associated with this
type of coughing.She is on Amoxycillin and butrophanol which I understand is both a pain
killer and a cough suppressant. But a 1/2 tablet of a 1 mg. dose every
8 hours does not seem to be effective in controlling the coughing.Tony A.
Answer: Tony-
Coughing due to endotracheal tube irritation is fairly common. In some
dogs it can be severe, especially dogs with a pre-existing problem like
chronic bronchitis or collapsing trachea. There are a lot of factors involved in
producing the coughing, such as how tight a fit the endotracheal tube
was, whether the cuff was inflated too much or in some cases if deflation of
the cuff prior to removal created an ridge in the cuff the was irritating.
The cuff is like a balloon around the tube which is inflated to allow a seal
to be formed between the tube and the trachea. They are plastic and can
form irritating ridges when deflated. I didn't know that this happened until
I attended a seminar in which the speaker showed a few slides from
endoscopic views of the trachea after removal of anesthetic cuffs. These are
usually minor problems.In some instances a complication like vomiting during the surgery occurs
and there is some laryngeal or tracheal irritation from the contact with
the vomitus. There would be a small chance of inhalation pneumonia even
with an inflated cuff but usually this is not a problem when a pet is
intubated.There are probably some instances in which the tube contacts an infected
surface, like an inflamed tonsil, prior to being passed into the trachea
and infections occur that were not present prior to the surgery. I don't
think this is a common problem but it is why antibiotics are often
dispensed.The dosage for Torbutrol (Rx) can probably be increased, if necessary,
but it would be best to contact your vet about this. If Torbutrol is not
effective your vet might be willing to prescribe hydrocodone. We use
dextromethorphan sometimes, too. The dosage for small dogs is 5mg every
4 to 6 hours. There is a product called Cough Tabs (tm) for dogs that
contains this ingredient.Mike Richards, DVM
11/11/2001
Collapsed trachea - teeth need cleaning
Question: Dr. Richards.
My dog is a 13 year Shih Tzu who has a collapsed trachea. My vet has
not heard of dogs receiving mediacion for this condition. What can I do to
make her life more comfortable? She always seems to have a head cold and
runny nose but has no fluid in her lungs and does not run a temperature. Her
teeth are dirty and recently when she went in to have her teeth cleaned. Much
to our surprise she almost died before she was completely sedated. The vet
told me that if it was her dog she never would have my dog sedated unless it
was a life or death situation. My dog was been sedated by other vets many
times in the past. This vet told me to let her teeth go because the risks of
sedation were too great. I cannot clean her teeth because she won't let me
get near her mouth and she has breathing problem if I try to restrain her.
Thanks..JamesAnswer: James-
Dogs really benefit from having bad gingival problems and loose teeth
tended to. It is amazing in some older patients how much difference this
makes in their quality of life and longevity. I understand the reluctance
to anesthetize her. Surprisingly, having one anesthetic crisis does not
mean a dog will ever have another one. We have a number of patients in our
practice who had trouble during one anesthetic event who we later
anesthetized with no problems. I would recommend finding a practice that
uses a well trained veterinary technician or another veterinarian to
monitor anesthetic procedures and try to find out what anesthetic protocol
caused problems the first time and use a different one. Ideally, you could
consider a trip to a veterinary school or large referral center employing a
veterinary anesthetist. This is almost the only way to have an anesthetic
procedure monitored by a trained anesthetist in veterinary medicine and I
am sure that is one of the reasons that the anesthetic death rate is much
higher in pets than it is in humans. To be honest, though, I would
anesthetize a pet of my own again, even after an anesthetic crisis, to deal
with bad teeth. I honestly think it is worth taking some risk to get the
benefits of this procedure.There are a number of veterinary texts that cover the treatment of
collapsing tracheal through medical means. There is a somewhat
controversial article in the newest "Kirk's Current Veteinary Therapy
(XIII)", which discusses this condition in some detail. The authors
recommend using diphenoxylate (Lomotil Rx) to treat the collapsing trachea
problem but this is a controversial therapy. We have tried it in two
patients without much success. We have a lot better luck with cough
suppressants and low doses of corticosteroids, usually prednisone.Please ask your vet to review her textbooks for information on treating the
collapsing trachea. Almost everytime I pick up one of the Kirk's volumes I
find new information on treating conditions that I had not noticed in the
book before because I tend to use the books to look for specific
information rather than sitting down and reading the whole book. I suspect
most vets do that and therefore miss information on some of the conditions
covered in the books, just as I do.Mike Richards, DVM
2/10/2001
Bronchoscopy to check cough with tracheal collapse
Question: Dr. Richards,
I have written you before regarding my dog, Scout, but
here's a quick recap: He is a young (1 to 3 years old)
Chihuahua/terrier mix who has been suffering from
allergies for the past two months. His symptoms have
included face rubbing, paw chewing, general itchiness,
sneezing and reverse sneezing, a runny nose, hot spots,
and a cough. He has tested negative for heartworm.
His bloodwork shows no major infection. He has taken
two courses of antibiotics and takes Heartguard Plus,
which I understand provides some protection against
lungworm, nasal mites, etc.I recently had chest and tracheal x-rays done out of
concern for his worsening cough. Neither my vet nor
the radiologist who reviewed the x-rays saw any
evidence of tracheal collapse, but they both noted
some thickening of the lung tissue indicating mild
inflammation. My vet diagnosed him as having chronic
or allergic bronchitis and prescribed prednisone, which
he has been taking for about a week and a half.Scout's cough was improving on the prednisone, but
this past weekend after I had been rubbing his throat
his cough worsened again for a few days. He still
coughs when he is excited or stressed and occasionally when he eats or drinks.My questions are:
1. Am I right to infer from your comments on vetinfo
that x-rays cannot always detect tracheal collapse?
Is it common for x-rays to miss tracheal collapse?
Scout's x-rays were taken on inspiration and
expiration. At what point would a bronchoscopy be advisable for Scout?2. Does bronchitis cause increased tracheal
sensitivity? I am especially wondering why Scout's
cough increased so dramatically after simply rubbing
his throat a few times and why the irritation (if that
is what caused it) persisted for several days. I can
understand why rubbing his throat might cause him to
cough while I was doing it, but not why it would make
a difference later in the day.3. What type of anesthestic is used for bronchoscopy?
If Scout is intubated, would they be able to see
around the tube?4. Would you recommend bronchoscopy over a tracheal
wash in order to examine the cells of Scout's lungs?Thank you so much for your input. I am very, very
grateful for it.Amy
Answer: Amy-
It can be hard to detect tracheal collapse with X-rays. I don't have a good
idea about how often collapsing trachea fails to show up on X-rays but it
is often enough that almost all the veterinary texts warn about the
possibility of tracheal collapse even with normal appearing X-rays. It
shows up better with fluoroscopy, which is a form of X-ray in which
continuous motion is visible and it can usually be ruled in or ruled out
with bronchoscopy, which also allows taking culture samples and cytology
samples, which can aid in the diagnosis of other airway problems. It is a
good idea to consider bronchoscopy even in patients that have had confirmed
evidence of tracheal collapse on X-rays, because there are often secondary
problems, such as chronic bronchitis or inflammatory airway disease. If the
coughing persists, then Scout is a candidate for this examination. It is a
little unusual for collapsing trachea to cause problems in a young dog, as
it tends to worsen with age and many patients are older when they start to
cough or when they develop a persistent cough, but problems can be seen at
any age.Dogs with tracheobronchitis often cough when their trachea is palpated
(touched) during an examination. This is also true of dogs with collapsing
trachea. Sometimes, it is possible to palpate the weakness in the trachea,
when the problem is occurring in the portion of the trachea that can be
felt running under the skin of the neck. Both conditions cause intermittent
coughing, so this clinical sign is not very helpful in distinguishing
between the problems.Bronchoscopy can be done with most of the anesthetic protocols, including
gas anesthesia, and different vets have different approaches to anesthesia.
In small dogs, it may not be possible to intubate the patient but it is
possible to pass a small catheter for oxygen and anesthetic gas alongside
the bronchoscope according the descriptions of this procedure that I can
find. There are also several descriptions of using alternate anesthetic
agents, such as propofol, to maintain anesthesia during this procedure. I
don't have a bronchoscope so I have to rely on what I can find in the
literature to relay to you.Bronchoscopy is definitely a better choice than tracheal wash, if you have
a choice. If you don't, due to availability or cost, then tracheal wash
procedures can produce diagnostic samples and are a good second choice.
Bronchoalveolar lavage is also possible and while it is a more aggressive
procedure than tracheal wash, it may also produce a better sample for
determining what is happening in the lower airways.There are risks associated with bronchoscopy, tracheal wash and
bronchoalveolar lavage due to the procedures and to anesthesia, so it is
good to think about when they are actually necessary. We tend to try to
treat for bronchitis once before making the decision to proceed with one of
these procedures. If we have good success with antibiotic therapy and it
continues to work when we use it, we may not ever reach the point that we
feel compelled to do more diagnostic work. On the other hand, if antibiotic
therapy doesn't help much and we are not certain that allergic bronchitis
or collapsing tracheal problems are present, then we do like to refer our
patients for bronchoscopy and we are fortunate enough to have a specialist
who does this procedure within an hour of our office.Hope this helps some.
Mike Richards, DVM
11/27/2000
Hypoplastic trachea or Collapsing trachea in Sheltie
Question: Hi Dr.Mike,
Hope you are better.
I will share something with you for yourself. Get you some "Natren
Mega-dophilus" and some Good "Bifidus" that are always refrigerated. It
should help you alot. I take 1 Natures Plus "Bifudus" and "Natren
Mega -dophilus" just a little everyday and nothing has helped my Stomach and
intestines more.
Hope it helps you like it has helped many I know who take it.
I also take 2 capsules of Symbiotics New Life Colostrium once a day and it
has cleared up my skin so much. It is suppose to help your own immune
system. And I have heard alot about it helping Diverticulitis. I do not sell
any of these things I only take them because they have helped me so much. So
I wanted to Share it with you.......Wishing you the Best, BarbaraAlright my Question for you:
We found out our 1 1/2 year old Sheltie today has Narrowing of the Trachea
after X-rays or is it called a Collasped Trachea which I believe is the same
condition.
The Vet did not recommend any Medication, other than keeping our Sheltie
from getting over excited /which seems to make him worse when he gets over
excited, as he coughs more and than throws up.
She said the coughing was due to the throat narrowing down , and it makes a
Dog who has this Condition cough.Last night was the Worse night he ever had, because of so much Company
yesterday.
Do any of you know any Medication that helps this Condition or is there
Surgery that will help?I would be forever Grateful if any of you can help us make him more
comfortable with any good advice.
We do not want him to suffer with this coughing all the rest of his life.Thank you Barbara
Answer: Barbara-
Thank you for the suggestions for aids to my problems. It is good to hear
about things that help other people.It is possible that your vet believes that your sheltie has a condition
referred to as hypoplastic trachea, in which the trachea does not develop
its normal diameter as a dog grows. This is a congenital defect that has
been reported in several breeds, although I haven't seen anything referring
to it in shelties. There isn't much that can be done for patients with this
condition, although most of them are reported to do well if they are not
stressed, are kept cool in hot weather and do not have secondary problems,
such as defective tracheal cilia (the hairs that move mucous along the
trachea), laryngeal problems or elongated soft palates.The other possibility is that collapsing trachea is the problem. In this
case, there are medications that can help and surgery is an option.
Surgeons like to try to treat collapsing trachea early in the disease,
feeling that the surgical success rate is better. However, general practice
veterinarians are sometimes reluctant to consider surgery early because
when complications occur from surgery they can make the situation worse or
even cause the patient to die. This makes the surgical situation a quandary
-- try it early because the success rate is better, even though
complications still occur, or try to avoid surgery and then utilize it as
a last resort option if medical treatment fails? I still lean towards
avoiding surgery at this time.We usually try to eliminate secondary infections, utilizing tracheal wash
procedures to try to determine if bacterial infections are present unless
the pet owner will allow us to refer their dog for bronchoscopy, which we
consider to be a better approach. In a dog as young as yours, I would
strongly advocate confirming the diagnosis through bronchoscopy and also
obtaining cytology (cell) samples and culture samples through the same
procedure. This would allow the most comprehensive plan to be formulated
for managing the problem long term and also allow a good exam of the upper
airways to be sure there aren't complicating factors affecting the larynx
or palate regions.We start out with antibiotic therapy, if it seems indicated by the work up.
Sometimes we can eliminate the coughing for a long time, or at least
control it on a periodic basis, using antibiotics. Once this doesn't work
anymore, we usually try cough suppressants, most commonly hydrocodone and
try to keep the coughing under control in this manner. I am not a big fan
of bronchodilators, but some vets like them a lot as an adjunct therapy.
Eventually, we usually have to use corticosteroids, usually prednisone, to
control the irritation and coughing. I would try to put that off as long as
possible, within reason, though. It helps a lot to control weight in dogs
with this problem, shooting for just slightly below ideal weight, when
possible.I think that you do need to schedule a recheck with your vet since the
cough is worsening. It would help to find out if your vet suspects an
underdeveloped trachea or tracheal collapse during that visit.Good luck with this.
Mike Richards, DVM
11/27/2000
Tracheal collapse is a condition in which the trachea partially collapses as a dog breathes, leading to tracheal irritation, coughing and sometimes secondary changes in the lungs or upper airways. It is most common in toy breed dogs but can occur in larger breeds at times. It is likely that this condition is partially the result of breeding for small size. It is reported to be most common in Yorkshire terriers, poodles, Chihuahuas, pugs and Pomeranians have been reported to be the breeds most commonly affected by this condition (Slatter's Textbook of Small Animal Surgery) but it is reasonably common in all the toy breeds and several other smaller dog breeds.
The trachea is the airway from the larynx to the main bronchi in the lungs. It looks a lot like a "Shop-Vac" vacuum cleaner hose --- lots of stiff rings with flexible tissue connecting them. The rings are actually more like the letter C with the free ends slightly overlapping and are composed of stiff cartilage when properly formed. For some reason, the rings are not stiff enough in some dogs and they can't hold the trachea open against the negative air pressure created during respiration. The portion of the trachea that is not stiff is sucked into the airway, partially obstructing it and leading to irritation and coughing. This happens on inspiration when the portion of the trachea affected is in the neck region and on expiration if the trachea inside the chest itself is the problem. The irritation is self perpetuating, since coughing and increased respiratory efforts lead to further irritation and worsening of clinical signs. Eventually, damage can occur to the lungs, larynx or even upper airways (nasal passages and soft palate regions). Part of the problem is anatomical, but not all dogs with identifiable tracheal collapse show significant clinical signs, so other factors must be partially responsible. Obesity, irritants, allergies, obesity, concurrent heart failure, bacteria, viruses and obesity can all contribute to the problem, as well. If a pet owner smokes, this is another good reason to quit doing so. Smoking does seem to be a factor in
initiating and prolonging symptoms of tracheal collapse. The tracheal lining is ciliated and the cilia move in unison, sweeping a layer of mucous, antibodies and other protective substances constantly towards the larynx. This helps to keep foreign material out of the lungs. Chronic irritation of these tissues may make the overall disease in dogs with tracheal collapse much worse.Cats can have problems with tracheal collapse but it occurs much less frequently in cats than it does in dogs.
The symptoms of tracheal collapse are coughing, difficulty breathing and tiring easily. The cough is usually very harsh, often sounding like a "goose honk". When this condition first occurs many dog owners truly believe that there must be something caught in their dog's airway due to the severity of the cough. In many cases, dogs with tracheal collapse will also have other airway problems such as stenotic (too narrow) nostrils, soft palate disorders and laryngeal damage. Secondary lung changes can occur with this condition that eventually lead to chronic obstructive pulmonary disorders. If the tracheal collapse is occurring inside the chest the increase in pressure on the circulation can lead to heart enlargement or contribute to heart failure. It is very important to evaluate patients suspected of having tracheal collapse very carefully to find problems that may be contributing to the collapse and problems that may be resulting from the collapse. Most other problems found should be corrected if possible since almost all of them respond to treatment better than the collapsing trachea itself. In some cases control of initiating factors such as stenotic nares (nostrils) may even alleviate the symptoms of collapsing trachea, at least for a while.
A honking cough in a small breed dog should make a pet owner or veterinarian highly suspicious of tracheal collapse. The average age of onset is somewhere between six and eight years of age but it can occur at a much younger age or wait to show up until much later in life. It may be possible to feel the collapse of the trachea with the fingers on exam. In some cases the narrowing of the trachea can be caught on an X-ray or by ultrasound exam. The best and most definitive way to diagnose tracheal collapse is with an endoscope, though. As the veterinarian looks into the trachea it is possible to see the collapse and to make an assessment of where it is occurring. In most cases the diagnosis is probably made by relying on the history and perhaps X-rays. This is a pretty reliable way to make the diagnosis since the history (including dog breed) and clinical
signs are very suggestive of this problem. However, if endoscopy were available at most veterinary hospitals I'm sure it would be the most common way to confirm the diagnosis. In any case in which response to treatment is questionable or when there are complicating factors such as concurrent heart disease it would be a good idea to ask your vet about referral to a specialist or veterinary hospital where endoscopic diagnosis is possible.There are medical treatments for collapsing trachea as well as surgical treatments. The consensus of opinion seems to be that collapsing tracheal problems are best treated medically until it becomes obvious that medical treatment alone is not going to work. Medical treatment is aimed at controlling the cough, dilating the airways if possible and controlling the secondary inflammation of the tracheal tissues. Bronchodilators such as theophylline, antihistamines such as terbutaline or hydroxyzine and combination products such as Marax (Rx), which is aminophylline, ephedrine and hydroxyzine are used to try to provide a more patent airway. Corticosteriods such as prednisone are used to control inflammation. Cough suppressants such as dextromethorphan, butorphenol (Torbutrol Rx), and hydrocodone (Hycodan and other, Rx) are the most useful medications in our clinic. Controlling the coughing often will allow resolution of the other problems associated with this condition and slow the self-destructive cycle that occurs with tracheal collapse. It is likely that cough suppressants are under-dosed more frequently than over-dosed in dogs with tracheal collapse. Many pet owners notice the most improvement with prednisone but under-dosing of cough suppressants may be partially responsible for this perception. Estimates of success with medical treatment vary but one study (R. A. S. White and J. M. Williams in the April 1994 Journal of Small Animal Practice) reported a 71% success rate with medical treatment. If medical treatment is unsuccessful after the initial attempts or if it becomes less successful over time, surgery is an option. The reported success rate of surgical treatment also varies widely in the literature but it appears that surgery is successful approximately 70% of the time as well. With surgery there is some chance, perhaps as high as 1 in 5, of the
dog being worse post-surgically, though. Laryngeal paralysis may occur due to damage to the nerves during placement of tracheal ring supports and it may be necessary to do a permanent tracheostomy if this occurs. In a recent report in the AVMA Journal, Drs. Bubjack, Boothe and Hobson reported that this was necessary in 10 out of 90 patients treated surgically. They felt that the best surgical results were obtained in dogs with early onset of tracheal collapse when surgery was performed prior to six years of age. It seems to be the consensus among surgeons that tracheal collapse occurring in the neck region is more likely to respond to surgical correction than tracheal collapse occurring inside the chest (thorax). In summary, medical treatment appears to be the best approach if the symptoms can be controlled with prednisone, cough suppressants,
antihistamines and bronchodilators, or by any combination of the above medications. If there is a poor initial response to medical therapy or if the response deterioriates over time, then surgical treatment should definitely be considered, especially if the collapse seems to be occurring in the cervical (neck) region of the trachea. Treat any possible initiating causes found on careful exam of the pet and treat any secondary problems that occur after the diagnosis of collapsing trachea. Dogs with this problem should probably be examined at least twice a year to allow early detection of any secondary problems that do occur. Weight loss is often enormously beneficial but can be difficult to achieve in a pet that has limited ability to exercise. While it may be very difficult to enforce a strict diet, the end result could be a much healthier and happier dog.The best reference for a more detailed understanding of tracheal anatomy, function and disease is probably Slatter's Textbook of Small Animal Surgery, 2nd edition. This is a two volume set and it has detailed explanations of normal anatomy and normal function and how they are changed in disease states for many problems that will respond to surgical correction.
Mike Richards, DVM
Paroxysmal respiration, or reverse sneezing, and collapsing trachea syndrome
Question: Dr. Mike,
Can you tell me if there is a relationship between
reverse sneezing and tracheal collapse? Most of the
articles I've read say that the causes of reverse
sneezing may include allergies, post-nasal drip,
viruses, or infections. However, I've come across a
few articles that equate reverse sneezing with tracheal
collapse or obstruction.Are the authors confusing the conditions because they
both produce a honking-type sound, or is there a
correlation? I wrote you recently about my dog's
cough (possibly due to tracheal irritation), and now
he has begun reverse sneezing once or twice a day.
Naturally, I am concerned.Thank you so much for the time you put into answering
our questions. You are appreciated.Amy (Scout's Mom)
Answer: Amy-
I am certain that the condition referred to as inspiratory paroxysmal
respiration, or reverse sneezing, and collapsing trachea syndrome are
totally different conditions.However, I think that the symptoms of these conditions are very similar in
some cases, though. Especially in dogs with severe coughing episodes
associated with the tracheal collapse, which can look a lot like the
extreme inspiratory effort that is typical of reverse sneezing.There are other reasons for confusion between these conditions. They both
occur most commonly in small breed dogs and it is likely that there are a
number of dogs who have both conditions. Tracheal collapse can be
aggravated by any other condition affecting the respiratory tract, making
it possible for a dog with reverse sneezing to develop tracheal collapse
symptoms over time.I think that there are probably a number of causes of reverse sneezing and
that many cases occur for no discernible reason. According to the "Textbook
of Veterinary Internal Medicine" by Ettinger and Feldman, swallowing stops
attacks of reverse sneezing. This source says that reverse sneezing may be
controlled by massaging the pharyngeal area or briefly closing the dog's
nostrils. Several of my clients have mentioned that their dogs respond to
rubbing of the upper neck region, so this advice may be useful. Reverse
sneezing is a problem of the pharyngeal region.Tracheal collapse is a problem that occurs because of improper formation of
the tracheal rings. Weakness in the tracheal rings leads to a condition in
which the trachea collapses, either during inspiration or expiration,
depending on the location of the problem in the trachea. This is highly
irritating to the dog and coughing results.Reverse sneezing tends to start at an early age and to be a persistent
problem. Tracheal collapse may cause some symptoms at an early age but in
most patients there is a gradual increase in coughing over time and it may
reach a point in which there are coughing episodes that last for several
minutes and do resemble reverse sneezing. Severe tracheal collapse symptoms
are more common in older dogs.Mike Richards, DVM
10/26/2000
Tracheal irritation from trying to leash train
Question: Dr. Richards,
First of all, I want you know how very much I
appreciate VetInfo! It is by far THE best source of
pet information I have found on the internet. I
was happy to subscribe.I am beside myself about my Chihuahua mix,
Scout, and I hope you can help. Two days ago,
I took him for a walk with a choke chain for the
first time. We were working on the "heel"
command, and though I don't believe I was
unusually harsh, I did jerk on his chain many times
in order to correct him (with a "pop and release"
action). I don't remember him choking, coughing,
or making any noises at all during the walk or
later that day. However, when I brought out his
dinner that night (approximately 9 hours later),
he was, as usual, very excited, spinning in circles
and jumping, and he began to make a honking
noise like a goose. He did it about 4 times in
rapid succession and then settled down to eat.My husband and I took him to an animal clinic that
night. The vet pressed up and down his trachea
and could not get him to "honk" again, although
Scout did cough slightly when he pressed hard.
The vet's opinion was that I had irritated his
trachea and that a tracheal collapse was unlikely.The next day, I had Scout on a regular collar and
leash on a walk. He went after a bird and pulled
very hard against his collar. He then retched
once, like a cat trying to cough up a hairball. When
we came in, he had a drink and retched once
again.This morning, he may have had a very slight
muffled cough a few times, but I am not positive
that he wasn't just "wuffing" at someone outside.
I took him to our regular vet, who also palpitated
his trachea (and listened to his lungs and heart,
etc.). Her diagnosis was also tracheal irritation,
but she also gave me some Clavamox, because
I noticed a little bit of mucus on one of his chew
toys on Monday (the day I first used the choke
in) and a little bit after he sneezed on me
on Tuesday.Some other information that may or may not be
related: About a month ago, we changed his
food, and about two weeks ago, we started giving
him Metamucil to try to keep his anal glands
empty. He was allergic to either the food or the
Metamucil, and he began chewing his paws
constantly. His fur also began to shed much more
than usual. He is now on a plain lamb and rice
diet and is doing much better, but last week and
this week he has still been somewhat stuffy in
his nose.Scout is about a year old. We have had him for
about three months. During that time, he has
occasionally (several times per week) coughed
as if he was trying to cough up a hairball. These
episodes don't seem to occur at any particular
time. Scout has been eating and playing just as
much as ever. He is not overweight, but just
right at 14 pounds. (We believe he is a Chi/Terrier
mix.)I still can't help but be worried that I collapsed
his trachea with the choke chain, knowing that
1. Chihuahuas have delicate tracheas and are
prone to trachea problems, 2. choke chains can
damage airways, and 3. he coughed when he
was excited, when he drank water, and when he
pulled against the leash.Am I just being paranoid, or could I have in fact
collapsed it? Would you advise x-rays or
endoscopy? Do you think we should use a
harness from now on?Also, when Scout was at the vet, he ate a treat
that another dog dropped from its mouth. Could he catch something this
way? (He is current on all
his vaccinations.)Thank you so much in advance,
AmyAnswer: Amy-
It is possible that Scout could have tracheobronchitis, which is a
contagious disease that causes coughing. If that is the case, the coughing
has probably gotten a lot worse by now. Antibiotics can be helpful if this
disease is present.Tracheal collapse would be a little unusual in a puppy this age, but not
out of the question. The tendency to develop this disorder is congenital.
It happens because the cartilages that form the trachea are not as strong
as they should be. The trachea sort of resembles a vacuum cleaner hose,
with a series of stiff rings supporting connecting tissue. In dogs, the
rings are actually sort of "C" shaped, with the open ends of the C
overlapping slightly. In dogs prone to collapsing trachea, the ends of the
rings don't overlap and the tissue of the trachea is not fully supported.
Eventually, over time, the tissue weakens enough to cause irritation, as
the trachea collapses during respiratory efforts.It is unlikely that a choke collar will cause this sort of injury but it
does seem to exacerbate a tendency towards trachea collapse. I tend to
think your vet is right that the symptom is more likely to be from
irritation, due to this.In this situation, I would favor using a halter collar such as the "Gentle
Leader" collar, rather than a harness. The halter collar gives you the
opportunity to continue to correct Scout for training purposes, without
putting pressure on the trachea. Dogs object to these collars when your
first put them on so it is a good idea to talk to someone who has used them
before or to get your vet to show you how to put it on and adjust it if
your vet is familiar with these halters.X-rays can help to diagnose collapsing trachea problems but I would not be
in a hurry to take them, as long as Scout is improving. On the other hand,
if he is getting worse, or just not getting better, then it would be more
important to try to determine if this was a contributing problem.Scout it probably better by now but it might help prevent future problems
to consider using a halter style collar.Mike Richards, DVM
10/9/2000
Tracheal collapse and butorphanol (Torbutrol Rx) usage in Pomeranian
Question: Dear Dr. Mike:
Thank you very much for this service. I'm afraid my message will be long; I
apologize, knowing the volume of questions you must get. Let me say first: I
have a lot of faith in the clinic that treats my dog. I'm contacting you
because I found more information on your site than my vet had previously
shared with me.Prissy is my 9-year-old Pomeranian weighing four pounds. She's fragile,
easily excitable. She was three (?) when she was diagnosed with tracheal
collapse.She and I have learned to live with this problem. I administer Tobutrol as
infrequently as possible because it nauseates her and causes diarrhea.
Instead, when she has an episode, I push in her diaphragm so she cannot
"inflate" herself and cough. She then breathes shallowly for a few minutes
(5, 10, 15) until her throat opens, which I know has happened when she
begins to pant heavily. This is a daily occurrence. (I have other tricks
that help as well.)On two occasions her episodes have been out of control for about a week,
once when I went out of town and left her in someone's care and once when I
had her teeth cleaned. (She needs to have her teeth cleaned again, but I'm
afraid of another long episode. Her doctor-very capable-gently urges me to
have them cleaned.)I am currently in a three-week-long crisis. She hasn't gotten through one
night without Torbutrol for about two weeks. (I don't think her doctor
realized I had a supply on hand when he prescribed the last round because,
when I asked him if I could increase her dosage, he said I could do so only
about 10 days, that T is addictive. )My questions are these:
How much Torbutrol is too much? (The prescription calls for a quarter tablet
every 12 hours-I hope the tablets are a standard size because, I'm sorry, I
can't tell you how much this is. As I said, Prissy weighs four pounds.) I
have given her as much as three-quarters of a tablet to get through an
8-hour night. She seems to fare best when I give her a quarter-tablet every
8 hours. She had a cortisone (?) shot about a week ago, and she is on a
bronchodilator as well.What are the symptoms of addiction to Torbutrol? Is an addiction dangerous?
Is withdrawal dangerous?Why is it important to know where the weak cartilage is? (Prissy's doctor
has not mentioned an endoscopy.) Does its location improve a dog's chances
of responding well to surgery? Prissy's doctor is satisfied that her heart
is not enlarged.Am I unwise in not having Prissy's teeth cleaned? Her doctor does not want
to perform any operations without a tracheal tube, and I think I understand
this.How does one know if a dog's nostrils are the problem? Prissy's doctor has
not mentioned this; perhaps he is satisfied that Prissy's nare is OK...As I said: I have a great vet, and I respect his colleagues as well. But
reading your site led me to suspect your information might be more current
than his is. One can't have too much knowledge, right? Thank you very much.
Linda
Answer: Linda-
The recommended dosage for butorphanol (Torbutrol Rx) is 0.05 - 0.12 mg/kg
once or twice a day. A four pound dog weighs about 2 kg, so the dose should
be 0.1mg to .24mg two or three times a day. The smallest tablet that
butophanol is available in is 1mg. So the usual dose would be about 1/4th
of a tablet three times a day at the high end. However, there is a pretty
wide safety margin when using butorphanol, since the dosage at which
adverse signs begin to appear is around 1 to 2mg/kg or about 10 to 20
times the effective dose.I don't see the relevance of worrying about whether or not butorphanol is
addictive, since you control the dose, but this is an area of strong
disagreement among vets. My theory is that you can taper the dose off to
control any problems with withdrawal, if and when it is necessary to stop
the medication. Addiction is evident in dogs when they start bugging you to
have the medication. I have only seen this occur a couple of times in dogs
and they all were on phenobarbital for seizures. When addictive medications
are abruptly withdrawn, rather than being tapered, dogs will sometimes have
seizures or other neurologic signs. It isn't a good idea to abuse
narcotics, of course, but this is not as severe a problem in dogs, unless
the owner is contributing to the problem.Low doses of corticosteroids, such as prednisone given every other day (if
possible) often work well to control the coughing associated with
collapsing trachea and there is an chapter in the new Kirk's Current
Veterinary Therapy XIII that advocates the use of Lomotil (Rx) but this is
also controversial. If coughing suddenly worsens and stays bad for a couple
of days we often use antibiotics to try to be sure there isn't a secondary
infection. It seems to help sometimes but not all the time.Tracheal collapse that occurs within the chest cavity does not respond to
surgical repair very well but tracheal collapse occurring in the neck
region can be surgically repaired with reasonable success -- although the
failure rate usually makes veterinarians uncomfortable trying this approach
until it seems really necessary.Cleaning teeth can make a big difference in a dog's overall health and
comfort and it is worth doing this. It is reasonable to wait until a time
when the tracheal irritation seems to be under control for a while.If you can see the opening to the nostrils get sucked closed when your dog
breathes, the nostrils may be contributing to this problem. If that isn't
happening and there isn't a lot of nasal noise when Prissy breathes, the
nostrils probably aren't the problem.I know that many vets and many veterinary clients would prefer not to have
to use corticosteroids, but when there is continuous coughing for several
days it is worth stopping it, since the coughing itself can make the
problem worse. If this takes the use of prednisone or other
corticosteroids the use would be justified.I think I got to all the questions, but if not, please feel free to ask the
ones I missed again.Mike Richards, DVM
8/31/2000
Question: Hi. I'm a subscriber and wrote to you a couple of days ago regarding
bronchitis in my dog Noah. He is still breathing shallow and rapid. On
Thursday the vet changed his antibotic and put him on presodone. If this
doesn't work they may want to do a trachael wash. Can you tell me what this
procedure consists of? Will he have to be put under to do the test? What
are the risks? Will he have to spend the night? If hospitalized, how long?
Is a tube put down his throat or what? Thanks again for your help. Your
articles are always extremely informative. Brenda
Answer: Brenda-
There are several techniques for doing tracheal wash procedures. It is
possible to do a transtracheal wash in a reasonably calm patient using a
sedative or sedative/narcotic combination, in many instances. In this
procedure a needle is placed into the trachea and a catheter threaded
through it or over it (depending on the catheter type) and down into the
lung region of the trachea. Saline is flushed into the trachea and then
sucked back into the syringe for examination. This technique works better
in big dogs.Another option is to anesthetize the patient and pass a sterile
endotracheal tube into the trachea. A catheter is then passed through this
tube and down the trachea. Saline is flushed into the trachea and then
sucked back into the syringe. This works better for small dogs and cats.Even though it sounds pretty bad to flush fluid into the lungs the saline
is absorbed rapidly if it is not recovered and this procedure is very safe.
Anesthetic risk is always a worry but anesthetic problems are rare. We send
our patients home the same day and sometimes do this as an office visit.Hope this helps.
Mike Richards, DVM
7/14/2000
Question: Hi Dr. Mike..and yes, I am a subscriber....
In our rescue we recently began fostering a two year old little girl, very
tiny for a pug, about 10 pounds, who suddenly began having problems with
coughing, etc. When taken to the vet, we were notified that she had a
collapsed trachea, and apparently the nature of the collapse left a terminal
outlook. Not wanting to accept this, we took her to another emergency clinic
who agreed, saying the collapse was well into her chest, and that she may
have a year. She is on a bronchodilator and cough medicine and naturally, we
are heartbroken. Are there any other resources for this problem, or any
experimental procedures in the works? Your input is greatly appreciated, and
do you have any suggestions on how we can make her time one of quality.Pam
Answer: Pam-
I was confused by the information in the note because I don't think of
tracheal collapse as a fatal disease but rather as one that requires
maintenance but can be lived with in most cases.In researching an answer, I did find a couple of references to deaths from
collapsing trachea occurring at emergency veterinary medical facilities,
so apparently I am not completely correct in my thinking. On the other
hand, there are an awful lot of references to long term maintenance of
dogs with tracheal collapse, so I still tend to wonder about the validity
of the prognosis in this case. However, you have to remember that I have
not seen your pug and these veterinarians have.With that in mind, let me cover the basics of what tracheal collapse is,
what contributes to the problems with it and the usual maintenance
procedures that are recommended for it.Tracheal collapse occurs because of weakness in the cartilage rings of the
trachea. I think most people are at least somewhat familiar with what a
trachea looks like, but basically it looks a lot like the vacuum cleaner
hoses that have stiff rings with flexible material between them. For some
reason, in many small and toy breed dogs (mostly), these rings are not
strong. As time goes on, they do not support the softer lining material
(the dorsal tracheal membrane) very well. So it tends to droop into the
lumen of the trachea. When this happens, it causes a partial obstruction
of the trachea, leading to the clinical signs of coughing and even
difficulty breathing.If the tracheal collapse occurs primarily in the part of the trachea that
runs from the larynx to the neck, it is referred to as a cervical tracheal
collapse. These types of collapse tend to be worse when the dog is
inhaling. If the collapse occurs primarily in the part of the trachea that
runs through the chest, the problem is a thoracic collapsing trachea. In
this case, the difficulty breathing comes when the dog tries to exhale.
Some dogs have both cervical and thoracic collapse and a few dogs only
have collapsing of the trachea right around the junction of the cervical
and thoracic trachea.When the dorsal tracheal membrane collapses, it also becomes inflamed.
This inflammation makes the whole process much worse and further induces
coughing. The coughing itself causes more inflammation and the cycle can
just go on and on. As the problem gets worse, it tends to affect the
bronchi eventually and this makes severe respiratory difficulty more
likely. Secondary pneumonia or bronchitis can make the clinical signs much
worse until the problem is noticed and corrected.In pugs, there are often anatomic factors making the tracheal collapse
worse. If the nostrils are not large enough to allow good air flow, the
rest of the respiratory tract suffers. If the soft palate is elongated or
chronically inflamed, it makes the rest of the respiratory tract have
difficulties, too. Both of these problems are fairly common in pugs. In
this particular breed, I think it is really important to figure out if
there is an upper airway problem causing the tracheal collapse to become
worse more quickly than it would without these problems.Diagnosis of tracheal collapse can be accomplished with X-rays in many
cases. It is also possible to palpate (feel) the tracheal collapse in many
dogs with cervical tracheal collapse. Despite this, it is best, whenever
possible, to confirm this diagnosis with tracheoscopy, examination of the
trachea directly with an endoscope or bronchoscope. Prior to this exam, it
is a good idea to be sure there are no other upper airway
problems. During the tracheoscopic examination it is a good idea to
consider culture of the trachea to evaluate the bacterial residents and
biopsy if it seems necessary to the examiner.In all dogs with tracheal collapse any kind of tracheal irritant should be
avoided if possible. The most common contributing irritant is probably
cigarette smoke. Having a dog with tracheal collapse is as good a reason
as any to quit smoking, or at least to try to avoid smoking while around
the dog. Inhalant allergies are often a contributing factor to the
severity of tracheal collapse problems. Dusty environments, dry interior
environments in the winter and other things like this can cause
irritation. Think about the possibility of these types of problems and
eliminate them or control them to the best of your ability.Don't use a choke collar or even a regular collar if the dog pulls on the
leash a lot.Dogs with tracheal collapse are often a lot worse when they are excited
about something and wanting to bark and bounce than they are when they are
just doing ordinary exercise. For this reason, it is helpful to try to
control situations that lead to extreme excitement whenever possible but
not necessary to avoid controlled exercise.Long term maintenance of tracheal collapse is centered around the need to
control the coughing, control inflammation of the tracheal membranes and
provide a good airway to the trachea.I like to use hydrocodone for cough control. It has worked well for us. In
the most recent Kirk's Current Therapy, there is a recommendation to use
diphenoxylate and atropine (Lomotil Rx). Other authors have suggested
butorphenol (Torbutrol Rx). In any case, one of these medications should
be used to keep the coughing under control. If it is necessary to use
these continuously that is what should be done.Sometimes, cough suppression won't be enough. When that happens, low doses
of prednisone or another corticosteroid should be used to control
inflammation. If there is any suspicion of a secondary bacterial
infection, antibiotics may be necessary.I don't like to use bronchodilators, but many texts recommend them,
especially if there is bronchial involvement.It may help to use an essential fatty acid supplement, just for the
anti-inflammatory effect.When tracheal collapse fails to respond to medical therapy or when it
quits responding to medical therapy, there are surgical options. For
collapse of the trachea in the cervical region surgery works well in most
cases, according to the more recent surgical texts. The best prognosis is
achieved using external support with polypropylene rings or a spiral
prosthetic device. For collapse of the trachea in the thorax, the
prognosis for surgery is not as good but it still may be worth considering
in some cases.These are the basics of tracheal collapse. For your particular girl, it
seems very important to me to find someone who can evaluate the upper
airway well and then confirm the suspicions of the two veterinarians you
have already visited about the seriousness of the current tracheal
collapse problem. It is probably going to be necessary to go to a
veterinary school or larger referral center to find someone with these
capabilities.I have a pug breeder among my clients. I have seen one of these puppies
collapse and nearly die strictly due to stenotic nares. This puppy was
seen at an emergency veterinary clinic prior to coming to our practice, as
the problem occurred at a time I could not be reached. The EVC
veterinarian was not familiar enough with the severity of this problem in
pugs to recognize the underlying problem and was convinced the puppy would
die. It is still alive and it is at least three to four years after this
experience. While this may not be a typical problem, EVC vets often do
not get to see the long term follow-up of patients and may be a little
more pessimistic about some conditions than is really warranted, just due
to this difference in perspective between their practices and general
practices.If you can not go for a more complete diagnostic work-up due to financial
limitations, you can still do a good job of managing irritants,
controlling the cough and treating inflammation when it is necessary.Mike Richards, DVM
4/10/2000
Tracheal collapse possibleQuestion: I have recently become a subscriber. My questions and concerns are about
"Bob". Bob is a 10 year old cocker spaniel. He was in very good health
until he ate an overturned trash can with a lot of meat in it in August. He
became very ill; vomiting and diarhea. He was treated for food poisoning
and dehydration-- IV fluids, and subcutaneous fluids. As he recovered from this
trauma, his underside turned purple (blood) and when they ran a blood test,
his clotting factor was 0. He was put on an antibiotic and prednisone.
Over a period of many weeks he has been tested for his clotting factor which is
now up to normal. He developed a hacking cough that will respond to
nothing.
He has been xrayed-- they continue to look good, air space, no enlarged
heart, but diaphragm pushing right up on lungs. His trachea is in good
position and not collapsed. A ultrasound showed his heart to be in good
condition and not the cause of this cough. He has been vaccinated for
kennel cough. Two years ago he had valley fever which took many months of
treatment for recovery. His cocci test has been repeated several times and is OK.
His prednisone has caused him to gain about eight pounds. He has been treated
with hycodan, amoxicillin, pred, and theocron. This did nothing. He has
now been switched to torbutrol, baytril, amoxicillin and pred. He continues to
sound like a duck. Everyone is at a loss. His coughing increases when he
is excited. When he is out for a walk, it subsides. Do you have any
suggestions? Also what is the difference between Cipro and Baytril? Also
what is the appropriate dose of Baytril for a 38 pound dog. I would
appreciate any suggestions you might have as this dog is the light of my
life. Thank you. J
Answer: J-
Tracheal collapse does seem likely with the signs you are seeing. It is
best diagnosed by endoscopic examination of the trachea, rather than X-rays
or ultrasound exam. It can occur anywhere along the length of the trachea.
Prednisone often will suppress the coughing associated with this condition
but I'd still want to rule it out entirely even though prednisone didn't
seem to help much.Tracheal washes to allow culturing of the tracheal environment and
examination of the cells found in the wash fluid is sometimes helpful in
determining the best approach to treatment and in choosing appropriate
antibiotics. This can be done in combination with the endoscopic exam or
separately. Culturing may be a little more accurate if it is done
separately but that seems to be debatable.I am under the impression that coccidioidomycosis (valley fever) doesn't
usually resurface years after a successful treatment for it but I don't
practice in an area in which this infection occurs and so I have no
practical experience to back up that impression.Laryngeal paralysis and chronic laryngitis (or laryngeal inflammation) also
seem possible. Coughing is usually less of a problem than loud respiratory
sounds and obvious respiratory difficulty with this condition but I don't
think it can be ruled out without an examination. This has to be done under
anesthesia by visually assessing movement of the larynx. This is a little
difficult to diagnose with certainty. It can help to give doxapram (Dopram
Rx) intravenously while examining the larynx because it stimulates
respiration and leads to exaggerated respiratory efforts during the
examination.If there was vomiting during the food poisoning episode it might be worth
considering the possibility of a nasopharyngeal foreign body but that
doesn't really seem too likely.Ciprofloxacin (Cipro Rx) and enrofloxacin (Baytril Rx) are both antibiotics
from the fluroquinolone group of antibiotics. They are closely related and
there is very little difference between them in the bacteria they kill.
There are other fluroquinolones available but switching from one to another
is probably not all that productive since they similar spectrums of action.
The dosing requirements are different, though. This can make one more
convenient than another. Baytril is usually dosed at 5 to 20mg/kg of body
weight/day. At the present time there seems to be a trend towards using the
higher dosage once a day rather than the lower dosages twice a day.I can't tell for sure from your note what the blood clotting problem was
but it sounds like it was probably immune mediated thrombocytopenia which
is a decrease in platelet numbers. This can occur after severe infections,
due to some medications and several other reasons. I can't remember a
connection to food poisoning but can't see why it wouldn't be a potential
cause, either.Talk to your vet about having an endoscopic examination of the treachea and
bronchi and about the possibility of laryngeal paralysis. Although
anesthesia is necessary for these examinations it would be worth it with
the length of time this coughing has been going on, I would think. It sure
would help Bob out to get a break from constant coughing.Mike Richards, DVM
12/22/99
Q: Dr. Mike, I have a 14 year-old, old Lady Shih Tzu who has been having breathing
problems. Over several months we have found out that her problem is in the lungs, not heart,
after very nearly killing her with a heart med.which damaged her kidneys. We ruled out Cushings
last week (history of high alk-phos) as the specialist thought a possible hemo-something in her
lungs could be causing symptoms of Cushings. Specialist suggested, and family vet concurs, that
we do a bronchial washing to get a culture to see what is causing lung problems. (X-ray has
shown narrowed bronchial tubes; at first I was given the impression that this was something like
asthma and a bronchodialor would keep it under control. She has done okay on Theo Dur .) face.
This morning I had to rush her to ER Vet when she aspirated vomit. ER Vet thought it would be
a good idea to start antibiotics as he heard crackles in both lungs (which has been going on for
several months -- Lasix relieves), said she could have pneumonia, but he would not start antibiotics
when he learned that a bronchial washing/culture is scheduled. My question to him was: Why is a
culture the way to go here? Wouldn't a broad spectrum antibiotic have a good chance of getting rid
of an infection without putting her through another invasive procedure? He said yes, but said the culture
is the generally accepted way to go, and stated that he had to be political as he was working with two
other vets' patient. (Never mind what Mama here wanted, I guess.) My question to you is: Why
is a culture, rather than a broad spectrum antibiotic, the first step? I hope there is a good reason; this
girl has had breathing difficulties for several months, and countless tests, xrays, ultrasounds, etc. and
drugs that almost killed her. If a round of antibiotics takes care of this, I'm going to be a rather puzzled
and unhappy...
Shih Tzu Mama
A: V
I guess I'm going to tread the middle of the road here, because that is how I practice.
I think that doing a culture and sensitivity is probably best from a medical standpoint. The reasons are these:
1) it helps to ensure that the proper antibiotic is being administered because the culture identification gives the antibiotic type and the sensitivity test tells what antibiotics will work to kill it 2) it can take several tries to pick the right antibiotic, during which time the patient can get a lot worse 3) if more than one antibiotic will work then it helps to know that for future reference and finally, the tracheal wash may also identify another problem if cytology is also done on the washing (cancer cells, inflammatory cells, fungal elements and even sometimes another way of seeing the bacteria from the wash).There is a "but", though. Lots of times more than one organism is cultured and sometimes the culture fails to grow even though an infective bacteria is present. The procedure has some risk, although it isn't great.
So most of the time, we try a broad spectrum antibiotic first. If it isn't working well and we really think
the problem is bacterial, then we go to culture and sensitivity. This approach isn't always best, because
it is sometimes necessary to delay the culture long enough to clear the antibiotic from the system (because
it, in combination with the other antibiotics on the culture plate might confuse the results).I really do think that with the history you give it would be best to do the tracheal wash. More because
I think that you might find the underlying cause than because I think it is going to solve the problem by
identifying the current bacterial resident, though.I hope that isn't just more confusing.
Mike Richards, DVM
9/7/99
Q: Dr. Mike,
I have a 3 1/2 month old Pomeranian who has had a hacking, gagging cough for almost as long as I have had her, almost two months. The veterinarian has given her three different types of medicines, and nothing has cleared it up. I have heard that it is difficult to get rid of, but this seems excessive. We also give her children's cough medicine to try and ease the cough, but it is only mildly effective.
I am getting very discouraged and it is heartbreaking to see my little four pounder cough so hard it shakes her whole body. Other than the cough, she seems fine. She is eating well and growing. Do you have any advice for a desperate dog lover?
Christy
A: Christy-
If the medications are not working it would be a good idea to pursue diagnostic testing
to identify a cause for this problem. With coughing it is necessary to rule out airway stenosis,
tracheal problems, heart disease, lower airway disease, cancer, lung disorders and pneumonia.It is not possible to tell you exactly how to proceed without being able to examine your puppy. In
general, tracheal disease is pretty common in small dogs and it has to be considered as a possible problem.
Usually Pomeranians do not have too much trouble with stenotic (narrow) nostrils or upper airway obstructions
leading to coughing but it is a possible problem that should be looked for on physical exam, too. Tracheal infections usually do respond to antibiotics. If tracheal collapse is present it can be difficult to control coughing. The best way to diagnose this is probably with an endoscope so that the collapse can be visualized but X-rays are sometimes effective at showing this problem. X-rays are also good for ruling out odd lung diseases like congenital bullous emphysema, for ruling out pneumonia and for checking for heart size or shape abnormalities. Checking for heart problem with an echocardiogram (ultrasound examination) can be useful, too. Many veterinarians must rely on specialists for this level of care and it may be necessary to ask your vet for referral to an internal medicine specialist at this point.Mike Richards, DVM
Collapsing Trachea in Schipperke
Q: Dr. Richards, I have a Schipperke, he is 1 1/2 years old. Sometimes when he gets excited or pulls on his leash he honks like a duck. My vet said that he could possibly have a collapsed Trachea. He suggested using a harness when we walk and try not to get the dog too excited. The harness has helped but there are times that when he does get excited, he will start this honking and we have to settle him down. Should I persue having him x-rayed? Another thing I have noticed is when he sleeps at night and this usually occurrs most nights at around 3:00 a.m, I hear a sound coming from him that sounds like he is grinding his teeth. Do dogs grind their teeth? And sometimes when he is napping deeply, he may wake up startled and starts to cough or snore, like a person does when they snore. Are all these symptoms of the collapse trachea? What can be done? Your input is greatly appreciated and thanks ahead of time.
Shari B and Bugsy
A: Shari-
It would be a good idea to attempt to confirm the diagnosis of collapsing trachea due to the young age of your dog. The best way to do this is probably through endoscopy rather than X-rays if that can be arranged. In the meantime, it isn't a bad idea to use a halter, weight loss is beneficial if your dog is overweight and cough suppressants can be very useful in these conditions. Using a humidifier at night in the room he sleeps in might make breathing easier when he first gets up. Dogs probably grind their teeth but not many owners complain about this behavior so I don't have any idea how frequently it occurs.
Mike Richards, DVM
Q: Dr. Mike: I have a male pomeranian (just under three years old) that has been diagnosed with a grade II collapsing trachea. From what I understand, the collapse is (partially) intrathoracic. To reach this diagnosis, he has undergone radiographs, an echocardiogram, bronchial washes, a bronchcoscopy and allergy testing.
In February, he was scheduled for corrective surgery that was (thankfully) canceled. Currently, he is under the care of an internal medicine specialist and is being treated (21 days) with Clavamox for an infection. In the past, medications included prednisone, cough suppressants, aminophyline, and antibiotics. I'm not 100% certain of the response to any one medication due to the various combinations administered. I do believe that the prednisone had the greatest result.
Symptoms of his condition were evident as early as four months however, diagnosis was not confirmed until this past November. As I do not intend to subject this animal to surgery, my concern is with prolonging his health and quality of life. With the exception of this condition, he is in excellent health and is a very active (sometimes, TOO active!) little dog. His cough appears to intensify with changes in the weather (primarily cooler temperatures and rain). The cough itself tends to last from 10-20 seconds. Excitement and physical activity do not appear to be catalysts. "Whiskey" most often exhibits signs of distress in the early morning hours (I can sometimes even detect a slight wheezing while he is sleeping). Unfortunately, the cough visibly produces a great deal of fear in "Whiskey". Generally, it seems to help (or perhaps just calm him) when I pick him up and gently massage his throat. I often wonder what he endures when I'm not home. I have observed a gradual increase in the coughing throughout the past two years. Initally (as a puppy), he coughed so seldom that he was diagnosed with Kennel Cough.
Although I have a great deal of faith in the specialist that I am currently seeing, she is available on a "referral only" basis. I will have to return to my "primary veterinarian" for continued care. This presents a bit of a problem, as my reaction (as well as another personal issue) to the canceled surgery (I was not informed that the surgery was canceled) appears to have caused some alienation. This is unfortunate, as I had a great deal of faith and trust in my primary veterinarian (not the surgeon).
At any rate, it is my hope to gain as much knowledge on this condition as humanly possible. It is of no concern to me whether or not the information is written in "laymens terminology". Any direction to sources of information will be greatly appreciated.
Additionally, I would like to find a veterinarian in my area that has the knowledge, compassion, and necessary communication skills to monitor his condition and administer treatment accordingly.
I've just barely skimmed the surface of information on this subject however, what I have learned has not been very uplifting. To date, I have very little information on what to expect when he's 4,5,6, or even 7 years old. I can only assume that the continued strain on his heart and lungs will shorten his life span, but again, I'm uncertain as to what I should expect.
On one particular x-ray, "Whiskey's" trachea actually "shrinks" in size by almost 50%. Am I correct in assuming that this condition may be genetically linked to the downsizing of the breed (30 lbs to 5-7 lbs) many years ago?
"Whiskey" (although spoiled rotten) is very dear to me, and I could not bear losing him prematurely without knowing that I did everything in my power to provide him with the highest quality of life and medical care.
This has been a VERY frustrating and time consuming experience.
Please help!!!!!!!!
Michelle
A: Michelle-
Tracheal collapse probably does shorten the lifespan of many dogs with the condition but it is often manageable for very long periods of time and it would not surprise me if Whisky lived nearly a normal lifespan. I have not seen any studies that specifically addressed the changes in lifespan
associated with tracheal collapse.It is possible that your vet is a little miffed that you did not follow his or her advice, especially if there was any reaction from the surgeon indicating displeasure at the referral that did not work out. Despite this, you can probably work this out with your vet. In most cases veterinarians really do want their patients to get better and are willing to accept that there are alternatives to their suggested course of action which are just as good or sometimes even better than their plan. It is hard to find a good vet and good clients are valued, too. You both appear to have reason to try to work out any problems. I'd be surprised if scheduling an office visit, discussing the internist's recommendations and asking your vet to work with you wouldn't result in a reasonable working relationship, if there was a good bond prior to this incident. It takes a lot of cooperation between the veterinarian and pet owner to successfully manage tracheal collapse over the long-term, so keep working to build a good relationship with your vet, or with a new vet if you go that route.
I think that comforting a pet often helps a great deal and that touch does often have a comforting effect.
Mike Richards, DVM
