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CASE REPORT: LARYNGEAL PARALYSIS

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Bubba

Bubba says- "CARPE DIEM"
 
 
Barked: Thu Aug 25, '11 6:20am PST 
This is a case report, also published in wilkipedia under CANINE LARYNGEAL PARALYSIS, describing LIFE THREATENING laryngeal paralysis rapidly presenting in our yellow lab Bubba, an otherwise healthy 12 year old male yellow Labrador retriever, the progressive worsening UNDER conservative (nonsurgical) management, and THE DRAMATIC RECOVERY following SPECIFIC medical management addressing a neuropathic etiology.

For over 12 years Bubba remained my very loyal companion, after my wife my best friend, my sailing and fishing buddy. WE SPENT many hours flying with me, weather foul or fair, night or day, until WE retired to our home in Marathon Florida few years ago.
Bubba and I enjoyed a swim and a 2 or 3 mile walk DAily, until three months ago when his exercise tolerance diminished. Bubba began to tire out much quicker, requiring a five or 10 minute rest before being ready to go again. With limited mobility, I use an electric scooter, accompanied by a good book, my harmonica and smart cellphone, these rest stops were not unwelcome.

Frequent rewards of dog biscuits increased Bubba's motivation, but while he struggled to keep going, retching , vomiting about a cupful of clear watery mucus ensued, followed by a croaking sound,(inspiratory stridor) accompanied by marked shortness of breath and rapid respiration. His chest wall intercostal muscles visibly retracted, sucked inward with each struggled inspiration.

Prepared to do an emergency tracheostomy, we rapidly conveyed Bubba to his veterinarian. His labored breathing spontaneously subsided, and after careful examination the diagnosis of laryngeal paralysis was confirmed.

The options offered being either conservative management or surgical. Opting for the conservative (nonesurgical) program, avoiding exertion, hot temperatures and fast feeding of large chunky food, afforded some relief, but Bubba's exercise tolerance over the ensuing months deteriorated, limiting his walks to less than 100 feet before the recurrence of croaking and dyspnea.

Faced with the ominous reality of surgery, fixing Bubba's paralyzed closed laryngeal folds laterally to open position, our natural born water loving pooch becoming a landlubber or destined to drowning, we started AGGRESSIVELY searching for alternatives.

In addition to being strongly motivated, My wife being a retired speech and language pathologist, and I having retired as a cardiothoracic surgeon, we were both FULLY prepared to study, revisit, research, and take a look at canine laryngeal paralysis from a different perspective.

We learned that Canine laryngeal paralysis is a common acquired problem in middle-aged to older, large and giant breeds of dogs, eg, Labrador Retrievers, Irish Setters, and Great Danes. It is seen less often as a hereditary, congenital disease in Bouvier des Flandres, Leonbergers, Siberian Huskies, Bulldogs, and racing sled dogs.

Diagnosis is based on clinical signs; laryngoscopy under light anesthesia is needed for confirmation. Laryngeal movements are absent or paradoxical with respiration.

Very interesting to us where the Electromyography finding, showing positive sharp waves or denervation potentials, and sometimes myotonia. Of greater interest were the frequent pathological findings of Denervation atrophy seen in histologic sections of laryngeal muscles.

This information focused our study to search for a neurological basis. By making careful observations of our excellent and cooperative Bubba, who while appearing healthy, very alert, eating normally, active, and anxious to play, Bubba clearly demonstrated the following pattern initiated by exertion; presenting itself with a single cough, THEN vomiting clear mucous, followed by the development of upper airway obstruction announced by a croaking sound and respiratory distress.
we coned down our attention to neuro anatomy and physiology, leading us to hyperemesis gravidarum of pregnancy, finally arriving at the not unreasonable hypothesis that canine laryngeal spasm may be neurogenic, reflexely mediated, closing and protecting the airway when the CTZ, or emetic center of the brainstem stimulates vomiting, for whatever reason.
Drugs that that depress the CTZ act directly on the emetic center or CTZ, are found to be more efficacious, used primarily to control motion sickness in people, include Meclizine(BONINE,) WHICH IS WELL TOLERATED IN DOGS, DOSE 4 mg/kg, PO, sid, IS REGULARLY AVAILABLE OVER THE COUNTER,
DRUGS THAT works by blocking H1 receptors in the vestibular apparatus and, to a lesser extent, the CTZ. SUCH AS Diphenhydramine 2-4 mg/kg, PO, tid, (benadryl, an antihistamine), IS ALSO REGULARLY AVAILABLE OVER THE COUNTER, AND WELL TOLERATED IN DOGS.
BUBBA WEIGHS 45 KG.
WE INITIATED THE FOLLOWING EXPERIMENTAL REGIMEN;
1. DIPHYNHYDRAMINE, 50 MG TAB IMBEDED IN A MILKY WAY, PO QAM.
2. Meclizine(BONINE,) 25 MG TAB, IMBEDED IN A MILKY WAY, PO QAM.
3. CLOSE OBSERVATION

RESULTS: IMPROVEMENT CLEARLY EVIDENT BY THIRD DAY, PROGRESSING; BY THE 9TH DAY BUBBA WAS RUNNING , CHASING AFTER HIS LADY FRIEND TERRA, A VIGOURUS MINI SCHNAUZER, AS SHE CHASED CATS AND CRITTERS BIG OR SMALL.
CONCLUSION: with humble humility, res ipsa loquitar

CASE REPORT: LARYNGEAL PARALYSIS

Edited by author Sat Aug 27, '11 6:03am PST

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Toto, CD, RN, CGC

We don't do- doodles!!!
 
 
Barked: Thu Aug 25, '11 10:34am PST 
VERY INTERESTING!!!!
Years ago I had an older Lab with L Paralysis, our only option at the time was rest when it happened. Interestingly enough, his started at about 5 or 6 years of age and he lived to be 13. It did get worse with age.
Who knew something as simple as those two drugs would work?????
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Bubba

Bubba says- "CARPE DIEM"
 
 
Barked: Sat Aug 27, '11 12:45pm PST 
http://www.dogster.com/dogs/795906
Toto, CD,- RN, CGC,
Thanks Toto for your response.
Do I detect correctly that we share a similar background in medicine? You're quite correct with your comments regarding simple medications. Benadryl and Meclizine have been with us for over 50 years that I know of, but their mode of action was never really understood. Recently, with the help of new technologies such as functional magnetic resonance imaging (FMRI) we have been able to get a real peek at them working in the brainstem centers, where all of our vital functions, even vomiting are controlled.

Cheers,
Bubba's friend , Gordon
goshannon@gmail.com
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Bailey

1204056
 
 
Barked: Thu Sep 1, '11 8:57am PST 
goshannon:

Thank you so much for your interesting and timely post.

I read it yesterday when I was searching for information about canine laryngeal paralysis.

Our chocolate lab, Bailey, has been exhibiting progressively worse coughing and gagging over the past several months. She's 13-1/2. Her quality of life has been gradually deteriorating, with her exercise dropping from 3 or 4 miles a day of walking to only a few hundred yards. Her hind legs have also been giving her trouble -- she has difficulty with stairs, and sometimes loses her balance when she is accidentally nudged while standing.

Our vet did not diagnose LP -- Bailey recently went in for a round of xrays to see if she had a lung mass or inflamed heart, and they told us she was simply a very healthy geriatric dog with arthritic knees from ACL surgery. They also diagnosed "geriatric bronchitis." They prescribed prednisone last week. Her coughing actually got worse since then.

I searched for causes and treatments of geriatric bronchitis, and the LP diagnosis fits her to a T -- I think her hind quarter weakness is primarily neurological, with some arthritis, and she also exhibits some minor facial paralysis along with coughing, retching, and very rare vomiting. Sounds like LP to me, but I'm an engineer, not a doctor.

We started Bailey on your proposed regimen of Benadryl and meclizine (generic) last night, along with her prescribed dose of prednisone and a Pepcid. Surgery is completely out of the question for a dog of her age and loyal companionship. We just want her to be comfortable for what we feel are her last few weeks or months of her life.

12 hours into the new meds, her coughing and retching have decreased about 90%, with no other ill effects so far.

Please try to notify me if you see problems developing with Bubba due to his new regimen. You have been so helpful so far, with the rest of the world relying on expensive and questionable surgical solutions for dogs who are really too old for such drastic measures.

Thanks for posting your case study, and good luck with Bubba.

I will keep you informed of any further developments with our pal Bailey
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Bailey

1204056
 
 
Barked: Mon Sep 5, '11 8:05am PST 
Well, not so good news for Bailey.

We started with the meclizine and Benadryl, and after receiving a private email from goshannon, we decided to stop the meclizine.

Over the past several days, Bailey's condition has continued to deteriorate to the point that she is vomiting clear fluid five to ten times a day. Her hind leg weakness appears worse. Yesterday, I stopped all medications including her steroids, and we have decided it's time to put her down tomorrow or Wednesday.

Very sad, but she's had a great run and she's been a fine companion. To watch her gasp for every breath at the age of 13-1/2 is heartbreaking.

My 3 sons were home from college and jobs this weekend, and they are saying their goodbyes.

We think this is the best way to respect Bailey's unflagging love, devotion, and companionship.

Thank you all for your help.
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Toto, CD, RN, CGC

We don't do- doodles!!!
 
 
Barked: Mon Sep 5, '11 12:13pm PST 
Ohh, I am sorry to hear about Bailey... I will be thinking of you and your loss!!! Godspeed, Bailey!
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Bubba

Bubba says- "CARPE DIEM"
 
 
Barked: Mon Sep 5, '11 1:43pm PST 
I'm also very sorry to hear about Bailey demize...

Having received the wrong med, we stopped the meclazine and changed Bubba's dose of benadryl to 75 mg 3 x daily,
(not to exceed 1 mg per pound 3 x daily).

the initial medical regimen being:
BUBBA WEIGHS 90 lbs.

1. DIPHYNHYDRAMINE, 50 MG TAB IMBEDED IN A MILKY WAY, PO QAM.
2. Meclizine(BONINE,) 25 MG TAB, IMBEDED IN A MILKY WAY, PO QAM.

having stopped the meclazine, Bubba continues to improve on benadryl alone,dose 75 mg) 3 x daily.
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Bubba

Bubba says- "CARPE DIEM"
 
 
Barked: Sun Sep 11, '11 1:02pm PST 
This is a case report, also published in wilkipedia under CANINE LARYNGEAL PARALYSIS, talks, Goshannon, which describes a LIFE THREATENING case of laryngeal paralysis presenting in Bubba, our 12 year old male Labrador retriever. who was considered a poor candidate for anesthesia and surgery.

Review of the Veterinarian literature provided little insight into the etiology of this deadly affliction. Reports describing laryngeal muscle denervation and frequent pathological findings of Denervation atrophy seen in histologic sections of laryngeal muscles plus the Electromyographic finding of positive sharp waves or denervation potentials, and myotonia, strongly suggested a neuropathic etiology.

The MERK veteranarian manual's section on dogs laryngeal physiology afforded us another clue; describing how the larynx was closed automatically during vomiting, as a natural protection of the airway, led us to try benadryl, a simple medicine given by mouth, known for many years to suppress the midbrain vagal centers and control vomiting, and his dramatic RECOVERY which followed.

Bubba, on a maintenance dose of benadryl, 100mg by mouth daily in am, remaines free of this strangling affliction for over 30 days now.

IT CANNOT BE OVER-EMPHASIZED THAT WHILE BUBBA NOW APPEARS TO BE FINE AND THIS REPORT OF ONE CAREFULLY CONDUCTED THERAPEUTIC TRIAL INVOLVING 1 DOG MAY BE SUGGESTIVE, MANY MORE STUDIES ARE NEEDED BEFORE ANY CONCLUSION IS REACHED.
ALWAYS ASK YOUR VET!

Gordon J. Shannon, M.D.
BACKGROUND; For over 12 years Bubba - - --
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Bubba

Bubba says- "CARPE DIEM"
 
 
Barked: Wed Oct 26, '11 8:31am PST 
Entering 3rd month of BENADRYL 100 MG every morning and BUBBA remains free of LARYNGEAL PARALYSIS.
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Lucille

I am the Sock- Bandit!!!
 
 
Barked: Wed Oct 26, '11 9:18am PST 
That's wonderful that Bubba continues to do well with this regimen! Thank you for posting here so that other dog lovers can be aware of this and mention the treatment to their vet.
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