Laryngeal Paralysis and GOLPP

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Laryngeal Paralysis and GOLPP

Laryngeal Paralysis or GOLPP is thought, at least in some breeds, to be inherited as an autosomal dominant trait.  It is perhaps something you’ve not heard of.  Do you have an older dog?  Have you noticed he is a little short of breath nowadays?  Is his breathing a bit raspy and noisy or perhaps faster than normal even when he isn’t doing anything?  Has his back end gone a little weaker and the muscles seem less defined than they once were?  Old age right?  Well, I confess that this condition hasn’t really been on my radar until the last year or so either, primarily because until then I’d never had a dog who’d suffered with it …. or had I?  Because a lot of the signs and symptoms are usually associated with old age anyway, I’m sure there are a whole lot more dogs with this condition than have ever been professionally diagnosed so it’s certainly worth taking a look at to see if any of this sounds familiar to you.

I’d like to thank the amazing members of the Laryngeal Paralysis (LP) Support Group on FB, and in particular the lovely Jo Field, for all the help, advice and incredible information in putting this blog together.  In my experience, these guys know more about this condition than most of the professionals out there so if any of this blog is ringing bells for you, you could do a lot worse than start your research and questions there.

Although, as per the title of this blog, I will be concentrating on the Geriatric Onset Laryngeal Paralysis Polyneuropathy, there is a version that affects younger dogs too and this can be brought about by parasitic infection amongst other things.

This is quite a “meaty” subject which I’ll try to put as simply and in as layman’s terms as I can as it truly is fascinating.  So, here’s the science bit

Laryngeal (pertains the to the larynx or the “voice box” as it is often known)
Paralysis (the loss of the ability to move (and sometimes to feel anything)

In essence, Laryngeal Paralysis is when a cartilage in the larynx (usually on the left side) stops working properly and this can cause difficulties with swallowing and breathing …. but its soooooooooo much more than just that.  It is actually a single part of a bigger condition called GOLPP (Geriatric Onset Laryngeal Paralysis Polyneuropathy) which basically means the condition happens in old age and has many nerve type facets to it.   I hope you’re still with me!

The reason this condition has so many signs and symptoms wrapped around rather than just breathing problems appears to be its link with the Vagus Nerve.  This nerve is pretty much the nerve that runs our entire bodies and all the different systems within it – a “super-nerve” if you will.  Because it is instrumental in how virtually every part of the body works, if it is damaged then the effects can appear in many different areas – and this is why it is known as a Polyneuropathy).  I noticed Axl went deaf very suddenly about the same time as he started demonstrating signs of LP and I’m now wondering if this is connected too!  To flesh out more about what the Vagus nerve is and does, check out the link below by DogDiscoveries.com
I am your dog’s Vagus Nerve

LP is said to be “idiopathic” in nature which really means they have no idea what has caused it.  Likely, it has been triggered through some kind of damage to the left side of the larynx, possibly through a knock, a jerk or even just the pressure of the sudden lunge on a collar.  For this reason, teaching your dog a good loose-leash walking technique and using a harness will help reduce the chances.  If you are looking into getting a harness for your dog, please choose one with an anchor point on the chest and on the back to give you the control of “steering” your dog that reins give when riding a horse.  See our early blog on harnesses at: R2S Harnesses

There are other possible reasons for such breathing difficulties which should also be considered such as growths, abnormalities or thyroid conditions etc, but the only way to get a definitive diagnosis of the condition is to have a scope put down his throat so that all the structures internally can be seen.  However, this in itself can come with it’s own risks due to the need for sedation, so many people opt not to go for this until their hand is forced, particularly if their own vet is reasonably confident of the diagnosis based on all the signs and symptoms your dog is presenting with:

Signs & Symptoms of LP
Coughing
Gagging
Yaking (as if trying to bring something up from the throat)
Change in the bark (either quieter or perhaps a more husky quality to it)
Licking the air or the forelegs (this could indicate acid reflux) Click here to see a video of this behaviour: Lip Licking
Increased anxiety
Noisy breathing known as Stridor (sounds like sawing wood, or living with Thomas the Tank Engine!)
Hind end weakness/muscle wastage
Sudden respiratory crisis (a bit like an asthma attack)
Faster breathing rate for no apparent reason

Living with LP
Eating can be a very hazardous occupation for an LP dog.  If any of the food or water manages to get into the lungs rather than the stomach due to the damaged laryngeal fold, aspiration pneumonia is a very real possibility that can prove fatal.  For this reason, many LP dog owners opt to hand-feed their dogs, particularly after tie-back surgery, standing up.  If you feed your dog raw, then roll the food into meatballs in your hand and pop them down his throat, standing up, with his head at about a 30 degree angle.  Personally, I use a spoon and kind of “quennel” the meat and he takes it from the spoon.  If you feed your dog kibble, then you can try soaking the food in a little water so you can make balls from that too.  This way, the food tends to go straight down the throat without particles breaking off and going where they shouldn’t.

Perhaps the most important thing to remember is how much of an impact the heat and humidity will have on an LP dog.  The best way to think of it is, if you are WARM, then he is HOT.  If you are HOT, then he is BOILING.  Certainly, I have seen a massive deterioration in Axl over this past summer which, for the UK, has been ridiculously warm and now that the weather is back to its normal rubbishy self, he is markedly improved.  When it is hot, it makes them stress.  When they become stressed, the tissues of their airways swell up making the calibre of the airways narrower making it more difficult to get oxygen in which in itself is very stressful.  This is a vicious circle.  A dog will pant to try to cool down and rid himself of excess heat.  If the atmosphere is humid, then this method of cooling is even less effective and the vicious circle becomes even worse.

Heat Management:
Balance any exercise he is doing with how hot it is making him become, and reduce accordingly.
Walk in the cooler parts of the day (a good tip for ANY dog guardian)
Invest in an air conditioning unit for the home to help during the summer months
Use cool coats (soaked in water frequently to insure against the sauna effect)
Wipe down with a cool wet cloth over the ears, belly and armpits/groins
Use iced treats such as frozen yoghurts
Cool mats for them to lie on can really help too

Surgery:
LP is a progressive condition.  It will deteriorate but at what speed depends entirely on the individual dog.  All you can do is watch, monitor and keep them as comfortable as possible.  When the time comes that their quality of life is an issue, then perhaps you might consider surgery as an option.  This is something that is not to be undertaken lightly and is probably more towards the end of the progression of the illness rather than early on.

Tie-Back Surgery:
This form of surgery takes one of the laryngeal folds (usually the left) and ties it back with sutures. It does come with a certain element of risk because, as we age, cartilage becomes more brittle which means it can cause surgery to fail during or after the procedure.  There is also the risk of Aspiration Pneumonia which happens when food or water “goes down the wrong way” and enters the lungs instead of the stomach.  The folds in the larynx are there to stop this from happening but, because this surgery ties one of these folds back, AP is always a risk that should be on your radar.  That said, I’ve seen numerous success stories with this procedure where dogs have gone on to live very full, happy, healthy lives with a new vigour for walks and exercise again, often resulting in increased muscle mass and tone and reversal of rear end weakness.

There is another surgical procedure where the fold is removed entirely or lasered.  This also runs the risk of AP as well as the possibility of the fold growing back.  I cannot comment any further on that procedure as I do not know anybody who has had this undertaken.

If you do decide to go down the surgical route, it is imperative that you research the professional who will be carrying out the procedure for your dog.  Make sure the specialist you are referred to has carried out the technique many, many times.  This is not a procedure to be done by your local vet unless he is fully certified in it … to put this in to perspective, in the US a vet who is a Board Certified Surgeon will have carried out the procedure in excess of 300 times to get his certification.  You want a vet who “knows his onions”!!!

For some dogs, surgery is not an option and for their owners this can be especially worrying.  Though still in research stages, there is encouraging evidence that the use of a human antidepressant could actually be beneficial.  The drug Doxepin is used to treat problems such as depression and anxiety.  By chance, it was given to a vet’s dog to treat something completely different and, completely unexpectedly, this had the side effect of helping the Flat Coat Retriever’s breathing problems substantially.  Since then, many other dogs have been tried on this drug, the effects of which vary from dog to dog and seem possibly to be dependant upon the severity of the damage to the larynx with cases where there is total paralysis likely to see no improvement at all.  Studies into this drug are still on-going, but if your dog is not a viable candidate for surgery, this may be something worth talking to your vet about.

Exercise:
Because of the change in their ability to exercise, your ever evolving role through this condition is to repeatedly find a “new normal”.  If you notice your dog is lagging behind on his usual walk, perhaps hesitating not wanting to go, or maybe just sniffing around a lot rather than actually walking, this may well be what is known as displacement behaviour – ie behaviour he is doing to distract away from what you are asking of him … and what he is reluctant to do.  You will have good days and bad days.  You do not NEED to finish a specific distance every day; a 20 minute WALK one day could well be 20 minutes of just sniffing around in the hedgerow for 100 yards the next 😉

Their abilities will change and you need to be inventive to keep their bodies and brains as active as possible, which in turn will hopefully slow down the progression of the condition.

Professional Maintenance Assistance:
McTimoney physiotherapy
Acupuncture

Daily Stuff at Home:
Walking purposefully over poles.  Proprioception (ie knowing where their feet and legs are) is great for their coordination.  When they have to pick up their feet to clear a pole or low bar (this should be no higher than the hock) it makes them use their muscles (and muscle memory) in the correct way.

Here’s a video of Axl a couple of days after a bout of bronchitis doing his poles.  You will notice we are walking very slowly.  Yes, this is partly down to the fact that he was just getting over a bad chest infection but also because I need him to make very purposeful, definite movements and the slow walk achieves that for him.  We do this for 5 minutes, twice a day: Proprioception over Poles

You can try shifting his weight from one leg to another.  I tend to stand behind Axl and gently sway him one way then the other so he has to shift his weight and his balance and use the muscles on both side of his flanks and back end to stay up right (for about a minute each morning).

Another good core and rear-end strengthening exercise is to use a wobble cushion.  Teaching them to step backwards onto the cushion will not only mean they are using their awareness of where their feet/legs are, but also the movement of picking the foot up and placing it backwards is great.  Add to this the need for stability and weight shifting on the cushion and you have a triple-whammy!  Depending on the size of your dog (you’ll want a big ‘un for a Ridgeback!!!), there are lots of good versions available, some specifically for dogs such as Paw Pods and other things by Fit Paws or you could even use a wobble cushion designed for humans.  Please ensure that the surface is non-slip to give your dog confidence when standing on what is already a very unstable surface.  Something like this, with rubbery nobbles on is excellent Wobble Cushion

You can try introducing mats with different textures on them and do foot targeting work.
You could pinch their toes/pads gently so the sensation travels up to the brain and completes the circuit.
You could use hair bobbles or vetwrap around their hocks to remind them where their legs are.
And of course you could trot them over a ladder or trotting poles to help with their coordination too.

There are lots of ways to help your dog and keeping his brain and body active will help keep him happy and healthy for longer.  If you decide to go down the surgical route, there is every chance it will be successful and give your dog many more happy years with you too.

VITAL HOMEWORK:
Please take the time to learn 3 things about your dog:
What is his normal heart rate
What is his normal breathing rate
What is his normal gum colour

These three things will alert you if he is starting to go into crisis.  The sooner you spot it, the sooner you will be able to get him the help he needs.  Last November, when I was blissfully unaware that Axl had any problems whatsoever, his breathing changed in the middle of the night from his usual 3 breaths per 10 seconds to 20 breaths.  I rushed him to the vet at 3am and he was diagnosed with Aspiration Pneumonia.  We were lucky … he got through it, I learned about LP and we changed his life accordingly.  He has been hand fed, standing up, ever since.  This week, 10 months later and one day before his 12th birthday, the same thing happened.  His breaths were up to 10 times in 10 seconds and I was taking no chances.  Off to the emergency vet and this time we were lucky enough to catch it at the bronchitis stage.  After a couple of days of anti-inflammatory pain killers and antibiotics, he was much more like himself.  If your dog has LP, you have my total empathy.  If I can help, just ask but please check out the Laryngeal Paralysis (LP) Support page on FB because a more informed bunch of people you could not wish to find.

Please indulge me, this video was a couple of days ago and I can’t tell you how pleased I am that he pulled through – AGAIN!  Here’s my boy Axl xxx  –  What a Difference a Day Makes

Comments

  1. Reply

    Fantastic post, thank you. I only realised that Lyra might have LP after reading a chance post: for months my vets had been reassuring me that her problems were ‘ just old age’ and ‘she’s doing well for her age’. When I asked specifically if she might have LP, the vet agreed, but you and the LP FB page have been far more informative than she was.

    • Reply

      To be honest, I think a lot of vets are just catching up on how involved LP is and a lot of times we were happy with “its just old age” as a diagnosis, I don’t think apply in all cases. Im glad you’ve found the FB group as they are one hot set of informed people! Im sure most of them are educating their vets which has to be a good thing for all those that exhibit signs in appointments to come! Lots of love, K.

  2. Reply

    Thanks for your tip on feeding my collie his usual kibble buy softened down with hot water
    It has made a tremendous difference to his LP breathing he still pants quite heavily but the horrible rasping has stopped.
    I hope your poor dog Axl will pull through this horrible weakness.
    Thanks again for your advice

    • Reply

      Aw Im so glad to hear that it has helped. Sadly Axl is in ICU as we speak on a drip but we are hoping for some magic and if the power of love and prayers can do anything, then with the amount coming from his followers he will be skipping out of there. Hope your collie continues to do well … all our love to you xx

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