Neurologist.

The Mama Writes:

Here's a break down of Pooka's recent visit with the neurologist. I'm recapping it in case it ever comes in handy for someone else!

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According to Dr. Glass, there are only something like 65 board certified Canine Neurologists in the entire country, so it may be particularly useful to have this information for folks who aren't fortunate enough to live 10 minutes away from one, like we are.

I'm not going to recap basic information about Laryngeal Paralysis because you can read that anywhere on the internet - this is just going to be a breakdown of what he did, the questions I asked him, and the information he provided me that I haven't seen elsewhere.

First he asked me a bunch of questions about Pooka's behavior, (eating, drinking, coughing, vomiting, sneezing, gagging, vocalizations, exercise, urination and eliminatory functions). Then he examined Pooka physically, testing his eyelids, reflexes in legs, (he actually tapped Pooka's knee for the jerk reflex with the little rubber hammer!!!), flinch reflex in eyes and other parts of the face, and then observed Pooka's movement at the walk.

Then he opened it up for questions.

Question One: Is Pooka's LP hereditary? (especially in light of his brother being diagnosed with the same disease)

Answer: Ultimately ALL giant breed dogs diagnosed with this illness have inherited it. This is because from an evolutionary standpoint, any dog that is larger or smaller than a small wolf is evolutionarily wrong, one way or another - they all have traits that would ultimately lead to evolutionary dead ends, if it weren't for the intervention of humans. But in the case of LP, and giant breed dogs, this is particularly because the nerve fibers are SO much longer than in your average wolf. The Laryngeal Nerve or Galen's Nerve starts in the brain, and travels all the way down to the heart and back up again, traveling then between the larynx and the esophagus to reach the neck. In a giant breed dog, that's a very long trip. Breakdowns can happen. And Pooka is a REALLY big Newf.

The doc then added that likely there are other neuropathies present besides just the LP, (he noticed some abnormalities in Pooka's hind end movement quite apart from his hip dysplasia, including a lack of flexion in the knee during walking), but that for the most part these won't have any, or any significant, effect upon his health - that these invisible neuropathies would be occurring and ending without any outward sign or symptom, and weren't anything to be concerned with.

Question Two: What Testing Can Be Performed for Underlying Neurological Issues that May Have an Effect on his Longevity

Answer: The tests he would order if it were his dog were:

Hypothyroid
Myasthenia Gravis
Serology for Infectious Diseases (especially protozoan diseases)

These are things that, if they are present, can be treated - which will have a slowing effect upon the progression of the LarPar.

He added that if a Thyroid test came back marginal, then the dog is not really being affected by the disease, and treating it won't be more than a placebo for the owners of the dog - giving them something to do. He said Thyroid, and Lymes, are the two most over-diagnosed neurological conditions that he sees. But it won't HURT the dog, more than likely, to treat it, and it does give the owners something to do...

Question Three: Which Surgical Option Is Safest/Most Effective - options being Arytenoidectomy, Partial Arytenoidectomy, or Laryngeal Tie Back?

Answer: Of all of them, the Tie Back has the highest rate of success with the fewest complications or dangers. This is because it is just tacking back a part of the body to get it out of the way, rather than completely removing it. The others will cause greater swelling and bleeding, and also require a tracheostomy during healing to allow swelling and bleeding to stop in the throat, and that increases the likelihood of infection and post-surgical complications.

I added that I had read that post-tie-back-surgery patients in a recent study had a median post-surgery life expectancy of 1,000 days. Dr. Glass said that almost all studies done of that sort are done at university hospitals, and that he believed that the median life expectancy of dogs operated on by soft tissue surgeons in private practice would be longer. He explained this as follows:

The surgery in University hospitals is usually performed by first year residency vets, or by teachers instructing a group. Because this is the case, the average surgery time in a university hospital is around three hours. He said he was drawing that number from his experience as a first year resident in a Uni hospital. In private practice, the same surgery is done in 30 minutes. He believes that the amount of time a dog is kept in surgery and under anesthesia can profoundly affect their recovery and their life expectancy post-surgery.

I also asked him who the foremost surgeon in the country for the tie back procedure would be - he said he didn't know - but that the surgery is very common and that nearly all soft tissue surgeons would be familiar with, and able to perform to their credit, the procedure.

I quoted Marvistavet's website where they say that the chief complication from the tie-back surgery is that since the adjustment is so small, (millimeters), pulling it too far results in a higher likelihood of aspiration pneumonia in post-surgery patients. I thought this sounded fairly common-sensical but he said that was nonsense.

I pointed out that even if the life expectancy was that quoted by the study, that 1,000 days post-surgical procedure isn't a bad lookout anyway, for a giant breed dog that only lives on average 8 to 12 years, and he said yes, that it is important to keep that in perspective - that if Pooka requires the surgery - it's entirely possible that he wouldn't require it for YEARS yet, and that by the time his LarPar has progressed to that point, he may have only had 3 years of his expected lifespan anyway. And many dogs that do pass, pass of completely unrelated causes since this is a disease that is usually diagnosed in elderly dogs.

BUT he stopped me there, to tell me that he wanted to make sure that I knew that there have been MANY dogs in his experience that have been diagnosed with LarPar and have never needed to have the surgery. He says being hyper-vigilant when it comes to keeping Pooka from experiencing moderate to high temperatures, or moderate to high humidity, scenarios will help prevent Pooka from ever having a respiratory attack. Observation and vigilance may provide Pooka with a long, surgery-free life.

Question Four: Since we were addressing respiratory attacks, I asked if there was any place where I could receive training in how to intubate a dog during an emergency situation.

Answer: This question floored him. He said in all his years of practicing no one had ever asked him that before, and that he thought I ought to ask Dr. Trotter - that it was possible he would be willing to provide that instruction or recommend a resource where I could learn it.

I mentioned that my husband was planning on taking an EMT course, but that I assumed that human and canine intubation procedures were vastly different. He said yes, they are very different. We would need to learn the canine methodology to prevent us from accidentally intubating into the stomach, which can create a life-threatening scenario all by itself.

Question Five: I asked if it would make sense for us to keep a sedative in our canine emergency kit, in the case of a respiratory attack.

(This being because a respiratory attack can cause profound anxiety in the dog, which worsens the gasping for air behavior, which only makes it more obvious to the dog that he can't get air and makes him more anxious, and causes a vicious cycle - the treatment for a respiratory attack is sedation and intubation).

Answer: This was another stumper. He'd never had anyone ask him this one either. His fear there is that in some cases, it can worsen the attack rather than alleviating it, and there's no way to know how the dog will react. He related a story from his very first day in practice, when TWO bulldogs came in with the exact same problem, (respiratory attack), both were medicated and treated exactly the same way, and one survived and the other didn't. He said since I live so close to the hospital that it would be safer to just race him in - but when I asked about scenarios where we were NOT close to the hospital and the choice was sedation and intubation ourselves, or likely lose the dog anyway, he suggested that I bring this up to Dr. Trotter, and see if he had any recommendations.

He again pointed out that vigilance in monitoring Pooka's level of heat-tolerance/humidity-tolerance and preventing overheating would go a long way toward preventing that nightmare scenario from happening.

Question Six: When Pooka's chest was xrayed for evidence of Megaesophagus, (important step after diagnosis of LarPar), was he also examined for masses and edemas?

Answer: Yes. There was no evidence of tumors, masses or edemas.

Question Seven: Supplements?

Answer: "If they worked, (vitamin E, selenium, etc etc), I would be selling them by the truckload. Again, they won't hurt but they're not going to have any effect upon the LarPar itself."

I ran out of steam around then. I'm sure that was a relief for the good doctor! But he said if any other questions occurred to me that I must not hesitate to call him. We drew blood for the thyroid panel, myasthenia gravis, and serology tests - I should have the results by this time next week.

I have to say it was a relief to get all of these questions out, and to hear the stories from the doctor of dogs diagnosed who never needed the surgery and lived out normal lifespans. It reminded me too that when Pooka was diagnosed with bi-lateral hip dysplasia at 8 months, we thought THAT was a death sentence, and he's been totally symptom free there all his life thus far. So we're crossing all our fingers and praying that Pook pulls the same miracle off with his LarPar - and that he's one of the lucky ones that the condition doesn't advance in.