MG signs started with the hind end weakness, which we realized afterward had probably been coming and going for several weeks before it became severe and she was barely able to stand. The hoarse bark came after along with the ME. The bark had gone hoarse sometime ago and we chalked it up to old age and the fact that he barks all the time!!! Then his breathing became labored and after chest xrays, etc. our vet gave an unofficial diagnosis of LP. We decided not to do the scope as we weren’t going to have him go through surgery at that age, but all the signs definitely point to LP. It’s fairly common in the breed also.
If he doe have surgery, we think it may be more dangerous with mega e to have the tie back surgery, as it leaves their trachea wide open to aspiration. There has been some discussion on the Veterinary Information Network about Doxepin helping dogs with LP. It acts as an anti-anxiety drug, and possible relaxer. I have used it in 2 dogs who had multiple issues as well as LP, and were poor candidates for surgery, and the owner and I have been pretty happy. Another thing that seems to help these dogs is daily (or more often) nebulizer treatments with albuterol. My theory as to why it helps is that the albuterol “opens up” the bronchioles, helping the “stuff” that might be aspirated, to be coughed out more easily.
LP cannot be diagnosed with x-rays. The pet needs to be anesthetized and the back of his throat evaluated as Dopram, a drug that stimulates breathing, is injected intravenously.
LP is indeed one of the most common co-existing syndromes w/ megae. There are a few things that may be helpful to discuss w/ your dvm, because surgery is probably not a food idea in these dogs:
1) doxepin (per posts on Veterinary Information Network) may minimize LP symptoms
2) albuterol w/ nebulizer treatments may minimize symptoms (1-3 times daily). The theory is that since megae dogs are prone to “micro” aspiration, the albuterol may help dilate the broncioles, encouraging “stuff” to be coughed up, more easily
3) sleeping w/ the front end elevated, and using a Pro-collar during sleep, may minimize the incidences of aspiration
4) if drinking water seems to worsen symptoms, thickening the water with Thick It or Thick’n’Easy may help
The tieback surgery is probably making AP more possible, as there is no way he can close off his trachea from stuff that refluxes up into his esophagus and into the back of his throat, then down his trachea into his lungs. Here are a few suggestions:
1) Sleep with front end elevated. If you look in the photo section, one of the first albums is “Eating/sleeping…” and there are photos of a slanted bed one of our members created. Having him wear a Pro-collar, will keep his head elevated, even when sleeping, to minimize the esophageal reflux from sneaking up into the back of his throat, and then into his trachea and lungs.
2) Nebulizing albuterol. Once the AP resolves, we have found in some dogs that continued 1-3 times daily nebulization seems to ward of re-development of AP. My theory is that by dilating the bronchioles, it helps the “micro-aspirated” stuff, to be coughed up more readily.
3) Metoclopromide administration before feeding may help the food empty from the stomach more quickly, allowing less “stuff” to remain in there and reflux up into the esophagus. The Cisapride may help that also. Bethanechol is supposed to help the motility of normal esophagus, but, no studies have been done on megae dogs. So, maybe that would help to propel food/water into the stomach, and minimize reflux (just a thought).
4) A lot of megae dogs are fitted w/ a feeding tube, which allows food and water and meds to be administered NOT by mouth. They still need to be held vertically afterward being fed, and esophageal reflux is still a possibility, but at least it bypasses the mouth, upper esophagus and trachea.
5) The medications he is on sound very good. My only other suggestion would be to, maybe, add metronidazole to cover some other “bugs.” I think w/ Troub, the problem is that “opened,” unprotected trachea, unfortunately.
Unfortunately, it has been found that megae and LP often go hand in hand. Michigan State University has published information about GOLPP (Geriatric Onset Laryngeal Paralysis and Polyneuropathy).
The tieback surgery may very well make management of the Megae more difficult, but, not impossible. One of the things that has a good chance of helping fend off frequent, repeated cases of aspiration pneumonia is daily nebulization with albuterol and saline. Coupage/percussion therapy, may also be beneficial http://www.youtube.com/watch?v=hrTqco9_jiE. Albuterol dilates the bronchioles, encouraging removal (coughing up) of debris that may be aspirated.