Sneezing
Question: Hi, Dr. Mike,
We have two dogs. Holly, a cocker/lab mix and Millie, a terrier mix (looks more like a Cairn than anything else). We've had to put the girls in day care many times over the last month due to landscaping and construction at our house. Mille has started sneezing recently. I looked up Kennel Cough on Vetinfo, but she really isn't coughing - no hacking, more through her nose like she has a cold or allergies. I don't see any discharge. I noticed today that Millie is also somewhat listless and she ignored her normal dinner dog food (Wellness Super 5 Mix because Holly is allergic to everything). She did readily eat all of the meat from a chicken breast. Millie also had a mast cell tumor removed last year and the prognosis was excellent. Does pneumonia start with sneezing? Is there anything else I should take into consideration. Thanks for any information you might have.
Judy
Answer: Judy-
Sneezing is not as common in dogs as it is in people in response to upper respiratory diseases, but it does sometimes occur. When sneezing persists, we usually want to look for an underlying cause, whenever possible. The most common underlying causes are allergies (not as commonly in dogs as in people, though), tooth root problems, foreign objects trapped in the upper airway system, infections of the nasal passages or sinuses, nasal passage parasites (nasal mites), nasal cancers and probably some other things I'm not thinking of. In Mollie's case, it would be necessary to think about the possibility of a return or spread of the mast cell tumor, but hopefully this is not the case.
I can't recall a case of pneumonia in which sneezing was an early sign. It is probably safe not to worry too much about this possibility.
The only thing you can really do if the sneezing has persisted is to start to look into the possible problems. A good physical exam, then tests like X-rays of the tooth roots and nasal passages, examination under anesthesia for a foreign body or signs of infection or nasal parasites (it may be necessary to have an endoscopic examination of the nose to find these), nasal flushes or other tests might be necessary. Your vet can help you figure out the best path to take to get to a diagnosis if that is necessary. Hopefully, Molly is better and it won't be.
Mike Richards, DVM 6/5/2001
Small foreign body in the nasal passages
Question: I just subscribed to your vet info. site. I have two Golden Retrievers. One of them just had surgery with an endoscope. We believe she got a small woodchip up the nose. Unfortunately nothing was found in the surgery. Sometimes I guess it is hard to find. She is still having trouble. Have you written anything on this subject? I look forward to the site and the vet info. digest. Thank you
Answer: Mary-
It can be really hard to find a small foreign body in the nasal passages of dogs or cats. It is also not unusual for dogs and cats with symptoms suggestive of a nasal foreign body to have no discernible cause when examined endoscopically. In a study published in the AVMA Journal (Willard, Nov 1 1999), 118 pets were examined endoscopically due to signs of nasal passage disease and a diagnosis could only be obtained in 43 of the cases. This is enough success to make the procedure worthwhile but it does show that it doesn't always produce an answer to the problem.
If the signs persist it may be worth trying the endoscopic examination again or trying an alternative procedure, such as nasal flushing, to see if the problem can be diagnosed or resolved. If these things do not help, it can also be helpful to take good X-rays of the tooth roots to be sure they are not infected and causing problems. If that does not help, an MRI examination is helpful in some dogs, although it is an expensive test. A more invasive approach would be to surgically explore the nasal cavity but that may be a more aggressive approach than you are comfortable taking, especially if you are really certain that the underlying problem is an inhaled foreign body.
Mike Richards, DVM 3/10/2001
Question: Dr. Richards, This is the first question I have asked. I am a new subscriber. Thank you for this service. I have 12 yr. old doberman spayed female. She is in good health for her age and breed except for bronchitis. She was diagnosed at the Uni. of Fla. about 2 months ago although she has had a cough for about a year. My local vet thought she had some type of respiratory problem. Her lungs sounded clear to him and still do according to the vets at the uni. I took her over there because nothing we tried locally helped. We tried 3 different antibiotics. I can't tell you what they were offhand. At the uni. they xrayed her and came up with chronic bronchitis. They say there is not cure but it is treatable with steroids. I am not in favor of using steriods until I have to because of the side effects. She has bad knees and some arthritis and I don't want her to gain weight. She also has a small problem with urinary incontinence. I was wondering if you had any other suggestions for controlling or treating her condition other than steriods. Any help will be appreciated. My dog means the world to me and I want to make her as comfortable as possible. It seems that lately her cough has gotten worse. Thank-you, Gordon
Answer: Gordon-
There are several things that may be helpful, other than corticosteroids, but there it is hard to completely control chronic bronchitis in a dog without the use of corticosteroids.
Antibiotic therapy usually doesn't help too much with chronic bronchitis problems in dogs, unless there has been a secondary infection from chronic irritation of the airway. Despite this, it can be helpful to get a tracheal wash or bronchoalveolar lavage sample for culture and examination of the types of cells present. This may have been done at the veterinary school, already. It is not unusual for dogs with chronic bronchitis to have normal X-rays and normal sound lungs on auscultation.
These are the things that help, other than corticosteroids, that I can think of:
1) If your dobie is overweight, that is contributing to the problem. I am always surprised by how much benefit there is to weight loss in patients with chronic bronchial disease and how many patients get worse as they get heavier when weight loss isn't possible. Controlling weight will have a major impact on the clinical signs of this disorder. Exercise might help with weight control but it has to be started gradually, if she is not used to it, because it can also irritate the airways. Over time, more active is usually better than less active, though.
2) Reduce environmental contaminants as much as possible, especially cigarette smoke and low humidity environments. If it is not possible to avoid a low humidity environment in the winter, consider using a humidifier in a small room for a few hours a day to help with breathing, if that is possible to arrange.
3) Bronchodilators like theophylline (Theo-Dur Rx, 20mg/kg twice a day) can be helpful. Beta-agonist medications such as terbutaline ( Brethine Rx) or albuterol (Proventil Rx, Ventolin Rx, 0.5mg/kg every 12 hours). There are several publised protocols for terbutaline use. The smallest tablet is 2.5mg and the starting dose should be around 1/4th of a tablet per 10 lbs of body weight. For bigger dogs 2.5mg to 5mg every eight to twelve hours should be sufficient, even if the "per lb." dosage seems to exceed that. If you use theophylline, it is important to remember that it interacts with several other medications, especially enrofloxacin (Baytril Rx), so it is important to adjust the dosage based on the other medications being used at the time.
4) If you wish to avoid most of the side effects of corticosteroids but still get most of the benefits, the use of corticosteroid inhalers is potentially helpful. I have not actually seen much written about the use of these medications in dogs but they are helpful in cats with asthma and so I can't see why they wouldn't be helpful in bronchitis, as well. The use of an anesthetic mask to make sure that the patient inhaled the medication would be necessary but these are inexpensive and should work pretty well for the purpose, even in a long nosed dog like a doberman. There is an article on the use of these in a recent Clinics of North America chapter by Dr. Padrid and your vet might have access to this journal.
5) In many dogs it is necessary to use prednisone to gain control of the coughing. It is often possible to use corticosteroids at a high initial dosage for a short period of time, such as 0.5 to 1mg/kg per day for 3 to 5 days) to suppress the irritation, then switch to a low every other day dosage quickly, limiting the side effects.
I hope this helps some.
Mike Richards, DVM 3/4/2001
Esophageal constriction problems in German Shepherd
Question: Hello Doc!
I have a 2 and 1/2 year old German Shepherd male that developed breathing problems about 8 months ago. His throat became inflamed inside and most symptoms passed after 2 weeks. Now, 8 months later, he doesn't have much trouble breathing but cannot eat any solid food. Before we discovered the problem, he had lost quite a bit of weight. He would try and eat but would cough the dry (mixed with water) food out of his throat in a manner similar to someone trying to clear his throat. It does/did not appear that the food stuck in his throat was coming back up from his stomach or intestines. After clearing his throat, he would try to eat again and then give up after about 3 attempts.
Our vet took initial x-rays and noticed a major swelling in one area of his throat/esophagus. To ensure that my dog did not have cancer, he then (additionally) took him through more x-rays at our local cancer institute. The results confirmed that while there is no cancer, it appears that for some reason his throat area is obstructed, and is now as narrow as the width of a pen. His inner throat/esophagus is not symmetrical, but instead looks like the shape of a tunnel (3/4 round and 1/4 flat where the swelling/inflammation is). He eats most of his food now because we now use can food and mix it with water until it is virtually a soup. He does not regurgitate his food at all. If he comes across a larger piece of food, it may still go down slow. His energy level is pretty good. He has put on more weight now.
He was training with me in Schutzhund and is going crazy because he stays home every night now. The throat problem does not appear to have been caused by any training, and the vet has not detected any foreign object lodged therein. I asked our vet about megaesophagus and he says that he is familiar with the defect and does not think my dog has megaesophagus. The vet has put my dog on antibiotics (over 3 weeks now) and it does not seem to have corrected the problem.
Have you heard of this condition before? Is there a place that we can consult that might be able to provide the best advice available for my vet? Thanks so much! Mike
Answer: Michael-
Esophageal constriction problems are not a common problem but they occur frequently enough that the veterinary schools and larger referral centers have experience dealing with them and there is a good deal of information in the veterinary literature on treatment options. The shape of the stricture that you describe suggests something outside the esophagus leading to the stricture since esophageal scarring tends to lead to a circular constriction, at least based on the literature. If your shepherd were much younger a persistent aortic arch would seem likely but this should show up right at the time a dog starts to eat solid food, not at 2.5 years of age. I have read of a few instances of treacheal/esophageal fistulas forming, usually due to trauma or foreign bodies, which might be a potential problem since this seemed to start as a respiratory problem. It is probably more likely that there was aspiration pneumonia secondary to a problem in the esophagus, though.
There are reported successes in dealing with esophageal strictures through dilation of the esophagus, using techniques such as balloon dilation or bouginage, which is the use of progressively larger rounded dilators to increase the size of the esophageal lumen. These seem to work longer term at least 30% of the time and it is acceptable to treat again when strictures form again. It is possible to replace portions of the esophagus, although this has a higher than usual instance of complications. Since your shepherd has a reasonably good quality of life with your present approach to this problem, this type of surgery might be riskier than is necessary.
If the stricture worsens over time, or if there is a problem outside the esophagus that can't be resolved, there are patients who do well over long time periods by implanting a feeding tube directly into the stomach. Hopefully this will never be necessary, though.
I would want to refer a patient with this sort of problem to one of the veterinary schools. I'm thinking that isn't a very good option in your case, though. If your vet has contacts with a surgeon who has used either the balloon dilation or bouginage technique in humans, he or she may be able to provide enough insight and expertise for your vet to feel comfortable pursuing treatment. If this isn't an option, your vet might be able to find useful advice through the Veterinary Information Network (tm) or NOAH (the AVMA's internet site). There is a good description of the techniques for esophageal dilation in "Small Animal Surgery" by Theresa Fossum, too.
Good luck with this.
Mike Richards, DVM 1/29/2001
Gurgling sounds when inhaling and exhaling
Question: We have an older dog, Lucky Dog, who is about 10. He was here when we moved in. He has had congestion for about 8 weeks now. I took him to the vet and he didn't like the looks of his red gums and teeth so he out him on antibiotics for a week and then I took him in for the cleaning of his teeth. The congestion never left. He out him on another antibiotic which was no help either. (He makes a "gurgling" sound but does not cough.) The VET took an e-ray of this throat and could not find anything wrong. His appetite has fallen off some which has never happened before, The VET did prescribe some Benedryl and after I finished the 10 pills I purchased over the counter ones and give him 1/2 a pill twice a day. The don't really seem to help. In the very beginning (before I took him to the VET) I tried Vicks Formula 44 which seemed to help more than the Benedryl but as I said, he does not cough. He just sort of "honks" and gurgles. He is outside in the daytime and sleeps in the house at night but the weather has been mild so far this season. (We live in the San Joaquin Valley.) Do you have any clues? How about Valley Fever? (I just thought of that.)
Thank you very much, Dixie
Answer: Dixie-
There are a lot of possible causes of gurgling sounds when dogs inhale or exhale. Laryngitis, epiglottitis, pharyngitis, tracheitis, laryngeal paralysis, collapsing trachea, pneumonia, heart failure, cancer of the airways and other conditions can all cause these symptoms. In your area, it does seem like checking for coccidioidomycosis (valley fever, San Joaquin Valley fever) would be a good idea, especially with the weight loss, as that is reported to be a common sign of this disease. If his lungs were X-rayed in the last X-rays, there is a good chance that signs of coccidioidomycosis would show on the films. There is a blood test for this disease which is supposed to be helpful in ruling it out when there is not clear evidence of the problem from clinical signs, X-rays, tracheal wash or other diagnostic procedures. Your vet will know a lot more about this disease than I do, almost for sure, since I do not live in an area in which it occurs.
If there is a chance that Lucky Dog was originally from another area it might be worth checking for heartworm disease (that is a problem in my area so I am sensitive to it) --- but I am betting that isn't a likely problem if he lived near your residence all his life.
If you have not already taken Lucky Dog back for a re-exam, that would be a good first step. It is sometimes a lot easier to diagnose a problem on the second or third recheck as the signs of the disorder become more clear.
Good luck with this.
Mike Richards, DVM 12/6/2000
Question: Zeus sneezes a few times a day, maybe six times. He has done this for months.I guess the sneezing is caused by the dust in the house. Generally, the other two do not sneeze, except Muffin (15) after having her teeth cleaned. Presumably six sneezes a day is nothing to worry about.
Answer: Sneezing can be associated with periodontal disease, allergies, upper airway infections, nasal mites (I have no idea if these are a problem in England but they are in some areas of the US) and probably a few other conditions. Most of the time, sneezing without some other evidence of disease is not too much of a worry but it might be worth having Zeus' teeth examined.
Mike Richards, DVM
Question: Hi Dr. Mike, I am a subscriber who wrote you about a month ago about my large mixed breed (90 lb male 10 years old (lab, border collie, newf?) dog (Noah) who was having rapid respirations (avg. 60 to 70 per minute; has been as high as 90 and as low as 40) but no other symptoms. At the time we thought it was bronchitis. This has been going on for about 10 weeks. Tests have ruled out Cushings. Low thryoid problems were found (very very low according to our vet) and he has been put on thyroid medication but this has not done anything to help respirations. Please note, he is not panting. These rapid respirations occur whether awake or asleep with mouth closed. He can't tolerate exercise and gets tired very easily.
Any information or thoughts you could give would be very much appreciated.
Thank you. Brenda
Answer: There are a lot of problems that can lead to rapid respiratory rates. Upper airway disorders such as nostrils that are too narrow, obstructions in the nasal cavity, pharyngeal disorders, laryngeal paralysis, tracheal collapse and tracheal parasites can cause rapid respiratory rates. Lower airway disorders such as bronchial constrictions (allergic, asthmatic, etc) can also do this. Heart and circulatory disorders such as heartworms, anemia and bleeding disorders can lead to increased respiratory rates. Injuries to the chest, ribs, sternum (including congenital defects) or the abdominal cavity which cause pain or bleeding can lead to increased respiratory rates. Things that cause fluid to accumulate in the chest cavity (cancer, heart disease, heartworms) can raise respiratory rates. I think that pain alone can do this and that stress probably can. Infections such as pneumonia, septicemia and probably osteomyelitis can do this. At this time, many of these problems have probably been ruled out --- but if one of them seems possible to you, it would be a good idea to ask your vet about it.
I hope this helps in thinking over the possible problems.
Mike Richards, DVM 9/10/2000
Question: Dear Dr. Richards - I have a 10 year old mixed breed (possibly lab, border collie, +??) 90 lbs, male, deep chested and short legged who has been in good health except for a pancreas problem for which we watch his diet very closely. He has some minor arthritis and takes 1000mg Glocosamine/Chondroitin in the morning and 500mg at night. This has helped him tremendously. About 9 days ago we noticed a change in his breathing pattern. His respirations were 78 but he otherwise seemed ok - good appetite, bright eyes, etc. We took him to the vet and she diagnosed bronchitis after checking his heart, lungs, etc. The diagnosis was based on x-rays. She put him on Baytril 1 1/2 tabs twice a day. After 2 days of taking the medication with no change she added Theophylline 100mg 2xdaily. It has now been a week and there is no real change in his respirations which are ranging 60-70 per minute. He has tested free of heartworm and is on heartworm medication. On Thursday he will be re- x rayed to see if there is change. Could we be missing anything? I am concerned that there has been no change. A friend suggested we look into a fungus as the source problem but I don't know. Any help or suggestions you might have would very much be appreciated. Thank you. Brenda
Answer: Brenda-
Labrador retrievers are prone to laryngeal paralysis, which can lead to significant alterations in their breathing rates or breathing patterns. It would be a good idea to consider this in an examination. Some of the hormonal diseases can cause increases in respiratory rates, most notably hyperadrenocorticism (Cushing's disease) and hypothyroidism, although we don't see increases in respiratory rates very commonly with hypothyroidism. Anemia can lead to increases in respiratory rate and we see this most commonly with hemangiosarcoma tumors in dogs in this age range. Allergic bronchitis may not respond to antibiotics or to theophylline, so it is a cause of bronchitis that has to be kept in mind, if the X-rays continue to be suggestive of a bronchial problem. A tracheal wash might help in determining if this problem is present. Tracheal collapse is unusual in big dogs but does sometimes occur. It usually causes coughing rather than increases in respiratory rates but once in a while it can cause panting or rapid shallow breathing. Pneumonia, including fungal pneumonia, is definitely possible but should show up on X-rays when it is severe enough to affect respiratory rates. Pain can cause increases in respiratory rate so it is always a good idea to try to be sure there is no source of pain or that a chronic problem that has been responding to pain control hasn't gotten worse. Often this is evaluation is subjective and you just have to make a guess about whether pain is increased. Heart disease other than heartworms is possible but usually will have some X-ray signs, such as heart enlargement or pulmonary edema which might show up on this next set of X-rays. Cancer is also possible and also usually shows up on X-rays when it is affecting the lungs (but might not if it is affecting the heart, causing anemia or leading to respiratory signs through some other cause).
These are the things I can think of. Rechecking and taking X-rays again is a good idea. If there is any question about the findings on the films, it is usually possible to arrange for a radiologist to review them. This is often standard procedure in human medicine but usually has to be requested in veterinary medicine.
There are enough causes of changes in respiratory rates that it may take several office visits and several different lab tests to finally localize the problem.
Hope this helps some.
Mike Richards, DVM 7/9/2000
Allergic Bronchitis or pulmonary congestion possible in French bulldog
I talked to the vet early Thursday and just happened to mention that Cowboy's biggest problem was the pain he felt when swallowing. I took him in to see the vet who examined the neck and throat and then put him on oxygen for a while...no change. On a hunch he then gave the dog an antiinflammatory injection. Lo and behold, Cowboy became calmer, relaxed and went to sleep. As it turned out, he had a very sore neck from a rough playtime and I never knew. He has been on Rimadyl since Thursday afternoon and seems to be his old self again. Still has his allergies but we will watch that till the neck calms down.(We will not keep him on Rimadyl forever...just 14 days.)
Thanks again..maybe this input will help someone else in the future!!
Jean Question: (All the symptoms etc. are very new to him..none of this has happened before.) Thanks so much for your prompt reply. Your input really helped.
His heart was normal on the x-ray...the ultrasound may be a near- future option...I am familiar with such examinations. Little Cowboy is feeling a little better right now. We are leaning toward an allergy-related situation....Benadryl 25 mg. quieted him down this afternoon..his "rattling" seems a bit improved..
I should say that this is a little dog with giant heart. He was very sick before he allowed it to change his routine and thus show elevated symptoms.. Maybe that''s how the allergies got out of hand.
I am very familiar with the great job vet schools do...thanks.
Just a thought...we have lots of deer here. Cowboy is fascinated by the taste of deer droppings. Is there a chance he could have picked up a bug from that, or vestiges of another wild animal that has roamed in our mountain area? On our walks, he does lots of intense sniffing.
Thanks again, Jean
Answer: Jean-
I am not aware of any diseases that are transmitted to dogs from deer by eating their stools. It is probably possible that some bacterial pathogens could be passed in this manner. The major disease that we worry about with deer is Lyme disease but that is transmitted by the ticks that also infest the deer, not directly through contact with stools.
Unfortunately, I can't be sure at all that just because I haven't heard of a disease problem transmitted in this manner that there isn't one.
I hope that Cowboy continues to improve. We have a couple of patients with allergic bronchitis. This is a condition that can usually be controlled reasonably well but isn't very likely to be cured. It often takes several treatment efforts to find the one that suits a particular patient best, so keep working with your vet on this.
Mike Richards, DVM 6/20/2000
Question : My French bulldog seemed to get sick suddenly last week. Lethargic, slow on his walk, then shivering. It has been very dry here, and I have felt like he had allergies related to dryness, etc. They did not seem severe enough to get concerned. Last week then I took him to his vet who did blood work, x-rays, endoscope. His lungs are very congested. His blood work is normal..no elevated white count. He seems very sore.. Seems to hurt to pick him up.
This little dog has never been sick in his 5 1/2 years. No elongated soft palate, his nose opening was widened early on. Very slight evidence of collapsed trachea..vet says not serious enoough to cause such congestion. I asked prognosis and he said "guarded".
He has been taking amoxicillin, 200 mg. 2x a day, albuterol sulfate 1/4 of 2 mg. tab 2x a day, and 1/4 of 10 mg torbutrol 2x a day. He .seemed to be doing better and was taken off the torbutrol today to start Theo-Dur 300 mg. 2x a day tomorrow. I have a strange feeling about Theo-Dur...can't explain. My pharmacist said it seemed kinda strong to him for a little dog like Cowboy.
(He weighs 32 lb.) Just a little while ago he had a reverse sneezing episode that scared us. He hunched up, moved around, became glassy eyed. I felt he was in pain. I gave him the torbutrol and after a while he relaxed and went to sleep. (Was very thirsty and wanted ice.)
The vet won't, or can't, say what is wrong, except that there is nothing anatomically wrong with him. What do you think? Are we doing the right thing? I know to expect respiratory problems with bulldogs...but not so suddenly and so severely, esp. in a seemingly healthy animal. Hope you can help. I feel his little life is hanging in the balance!
Thanks so much, Jean
Answer: Jean-
It is likely that your veterinarian has been considering the possibility of heart problems as a potential cause for the congestion in the lungs but you didn't list ECG or cardiac ultrasound examination among the tests, so it seems like a good idea to point out this possibility. I don't know of any specific heart problems in French bulldogs but individuals of any breed can develop heart related problems.
Allergic bronchitis can lead to pulmonary congestion when it is severe but that is often possible to detect with bronchoscopy and cytology (which was probably done during the endoscopy). Controlling this can sometimes only be accomplished by using corticosteroids but that is a problem if there is fear of an infectious cause.
Upper airway problems can lead to pulmonary congestion but it doesn't sound like that is a problem. Cancer is always a concern in non-responsive lung diseases but also is probably not highly likely.
We don't use Theodur (Rx) much, but only because I haven't felt like it did a lot for the patients we have tried it on. We have had a little nervousness in one patient while using this medication but no significant side effects other than this, that I can remember. So I tend to think it is reasonably safe but am not convinced it is all that effective. That's just my personal opinion, though. Lots of vets do use Theodur and think that it helps.
We see dogs that are afraid to be picked up when they pulmonary congestion from either lung disease or heart disease. I think that the pressure on their circulation from being picked up makes them uncomfortable or is frightening. Again, this is my personal theory, not something I know to be fact.
I would recommend asking for referral to a veterinary college or referral center for a second opinion. When dealing with a disease or disorder that isn't responding well to treatment and that seems as if it might be life threatening, getting a second opinion is important. Your vet has done a good job so it seems like it would be best to get a second opinion from a place with multiple specialists who can confer. This would be especially true if the condition is not heart related. Pulmonary congestion that isn't from a heart problem and isn't responding well to standard treatments is a difficult problem.
It is important to continue to seek a solution to this problem, whether you choose to work with your vet or to seek help through referral to a veterinary college or large referral center.
Mike Richards, DVM 6/16//2000
Question: Dear Dr. Mike,
Buddy has an occasional discharge from his nostrils. I first noticed it many months ago, but since it is not going to happen when I bring him to my vet to have a look, and since he seems in good health, I have been unsure as to how to handle this. The discharge looks like milk, pure white and liquid, and it accumulates at the lower outside of the nostrils. There is not enough for it to run, just enough to gather. .
Have you ever come across anything like this? Is it possible that it is *not* an indication of something horribly wrong? What things might it be, either not worrisome or worrisome? Is there something I ought to do about investigating this?
Thanks very much.
Best regards, Helen
p.s. I have a digital camera, and could try to catch it the next time it happens, if you feel that would be helpful.
Answer: Helen-
I would want to look at a smear of the exudate from the nostrils if Buddy was a patient of mine. This sort of exudate may be associated with irritation from allergies or it may indicate an infection of the nasal passages. If there is an infection it is sometimes possible to tell that from a smear of the exudate by looking for bacteria or fungal elements. The only problem with this is that the exudate has to be pretty fresh when the smear is made, so you would have to collect some on a cotton tipped swab and make a quick trip to the vet or you would have to bring home a glass slide from the vet's and make a smear by collecting some of the exudate on a cotton tipped swab and rolling the swab along the slide. We have been able to get good slides from a couple of clients whose pets had intermittent problems like this by letting them make the slide.
There is also a good chance that examination of the exudate won't be helpful. Lots of times there is just mucous or white blood cells and mucous but no visible infectious agent. In those cases you have to make a decision as to how important it is to know what is going on. Since Buddy feels OK and the problem is intermittent, there is good reason to lean towards just monitoring the situation and then treating if it gets worse. The other way to go is exam of the nasal passages, which usually means finding someone with an endoscope small enough to fit into the nasal passages. We refer these cases to the vet schools.
Ask your vet if there is a way to help him get a look at the exudate and then decide what the next step is based on what you find. If you can take a picture of what Buddy's nose looks like when the exudate is there and show it to your vet's it might help in explaining what is going on. I'd think that one taken with a digital camera and printed out would work.
Mike Richards, DVM 2/28/2000
Stenotic nares surgery and chronic upper respiratory problems
Question: Hi Dr. Mike! This is my first question (officially) and just to warn you, you will get many more. I am the Director of Alabama Pug Rescue and Adoption, Inc. I cater primarily to the special needs Pugs and own 7 of my many rescues myself to include a spectrum of cerebellar hypoplasia, epilepsy, deafness, and massive allergies. The reason that I am writing you this time is "Dolly" a three-year old beautiful girl who was sent to me last spring from Minnesota.
Dolly's initial needs were surgery for spay and hernia repair. She also had a cilia problem and scarring in one eye and subsequent surgery followed. My vet also recommended that we do stenotic nares surgery at the time of her spay, which we did, and was a failure. He had done this procedure before, but stated that there was so much tissue that he could not adequately open her up for significant relief. She does have decreased stamina, although she is not really a significant snorer like many of these other brachycephalic babes.
In September of this year Dolly came down with a case of tracheobronchitis which carried on for three weeks and was then treated with two different rounds of antibiotics. When there was no significant improvement, an x-ray was performed which showed a questionable enlarged heart, collapsed trachea and lung involvement. We were referred to a specialist in internal medicine. Findings were that the heart appeared normal, however the trachea was indeed collapsed at the portion closest to her lungs and that part of one lung was also collapsed. Treatment was started with Theophylline 200 mg twice daily and Prednisone. After three weeks there was some improvement, but when weaning off of the Pred the coughing began to flare again. She was put on another short term dose of Prednisone, and this time there was some improvement. A second x-ray showed improvement in the trachea but no change in the lung. The internist has suggested tracheal washing to obtain lung tissue if this problem persists, but has warned me that because of the condition of her lungs she is very high risk.
We have noticed with Dolly that before she has a flare up she has a foul odor that comes from her nose and/or mouth. Her teeth are in excellenent shape. This is a usual sign that we are getting into trouble, and this happened again recently and her primary vet reinstituted antiobiotics. Dolly sleeps with us, and when she sleeps, she sleeps hard, but when she wakes it almost like she panics. She rubs her face almost as if she is having an allergy attack, however she shows no other allergy symptoms (I currently give two rescues shots, so am familiar with the tell-tale allergy signs). She also appears to have some swelling under her eyes. She will blow significant moisture from her nose as well. I don't know if this is related to this underlying problem, but it does seem to all tie in together. She is now off antibiotics, and is being maintained on her Theophylline. It seems as though she has gotten herself into a repeating cycle, and I am afraid to go through with the tracheal washing, but I am also as afraid of what may happen if I don't.
Any advice would be very much appreciated.
I am also looking for all information I can find on cerebellar hypoplasia, or anyone who specializes in this problem in dogs. When you have time (I can imagine you have little) please read about my Hope at www.rescuepug.com/Alabama. I will promise to approach you with her at a much later date, in the meantime I am trying to understand all I can about her.
Your service is incredible and I am so glad that I finally am a subscriber.
Thank you in advance.
Pam Mayes Alabama Pug Rescue and Adoption, Inc. www.rescuepug.com/Alabama
Answer: Pam-
It isn't too unusual for stenotic nares surgery done on the external nares opening to only provide partial relief. There are often other anatomic problems in the internal nares and/or the soft palate region that prevent a total resolution of the clinical signs. In severe cases it can help to do surgical correction of the soft palate abnormalities but this is a surgery that is best left to a surgical specialist with experience in this type of surgery, due to the high potential for complications when doing surgery in the pharyngeal and palate regions. There is some evidence to suggest that early intervention to provide adequate airway flow does help prevent the development of secondary problems like tracheal collapse and chronic bronchitis.
Tracheal washes can be very helpful in identifying the type of bacteria involved in infections in the trachea and bronchi. This can also be a source of confusion, since bacteria are normal inhabitants of the airways in small numbers, so finding a bacteria that might be pathogenic does not necessarily confirm that it is currently causing infection in a particular patient. Sometimes, though, the bacterial culture clearly identifies a bacteria that shouldn't be there or that is very likely to be causing the clinical signs of chronic bronchitis/tracheitis to worsen.
If there is some other complicating factor, such as a fungal infection or cancer it is often possible to determine this from a tracheal wash. Inflammatory cells present can sometimes give a clue as to the cause of inflammation in the trachea.
This is a hard situation to figure out the best approach to. Ideally, patients with upper airway obstructions of any kind would be evaluated under anesthesia to see if they have a condition that can be surgically corrected. This provides the best long term solution to their problems and it helps to keep other airway problems from developing into severe problems themselves. If secondary problems like collapsing trachea are suspected, then tracheoscopy and bronchoscopy with bacterial culture and cytologic examination are the next steps to take in an ideal situation.
Unfortunately, patients with upper airway obstructions and secondary changes associated with them are poor anesthetic risks compared to the general population. This makes it a little scary to do the type of testing and possibly surgical corrections, that are the most benefit.
Our solution to this problem has been to refer patients we suspect need upper airway examination and possibly correction to facilities that have both an anesthesia specialist and surgical specialists. We usually use the veterinary schools close to us because they also have an additional benefit --- lots of veterinary students to provide around the clock monitoring post-surgically. This isn't a perfect solution since our clients have to travel several hundred miles but we have been lucky so far and haven't had a patient have severe complications that I can remember.
There is a chapter on managing chronic bronchitis and a chapter on tracheal collapse in the new Kirk's Current Therapy XIII book. Your vet might have this book. The mainstay of control of these problems is corticosteroid administration at the lowest possible doses that control the problem and the use of antibiotics and cough suppressants on an "as needed" basis as supplements. Usually it is necessary to control the problem long term since a cure is not likely after symptoms are present.
I couldn't find any references to cerebellar hypoplasia in pugs on an initial literature search but did find reference to this problem in a couple of other breeds (Gordon setters and Kerry blue terriers). I will search through the textbooks at the office to see if I can find anything else.
Mike Richards, DVM 12/14/99
Q: Hello Doc, you there?
I appreciated the very quick response to my last (which was my first) e-mail. I told the Schnauzer story and the Exxon the cat story. All Exxon's tests came back negative, the vet put him on Vibramycn and he seems to be feeling like his old self again.
On to my question...
My schnauzer, Cyndi, who has the medical history of heart murmur and chronic active hepatitis.. I noticed her right eye (the white part) is very red. I also noticed that her right nostril seems to be stopped up. If you cover her left nostril you can here her trying to breathe through the right. If you cover the right nostril you don't hear her breathing. She also seems to be breathing more through her mouth than you would expect. Her temp is 102.4 and she seems to feel o.k. and is eating fine. I am probably going to take her to the vet in the morning however it is a relief vet as my regular vet is out of town.. relief vet of course is not familiar with Cyndi and with her on-going medical conditions this concerns me.
Do dogs get sinus infections or could this be something going on, could her heart or hepatitis be causing someting else to happen. She is on medication daily for heart murmur. She was on Flagyl for two months...vet checking blood values on a regular basis. Took her off the Flagyl until next blood test to see if there was any change. She has been off of the Flagyl for about three weeks. Dog is 13 y.o., spayed female.
Any ideas - could sinus infection be a possibility or should I prepare myself for something else?
What is a dogs normal temp...102?
Thank you, Tina
A: Tina-
Dogs do get sinus infections and other upper airway problems similar to those experienced by humans. I think that we would be a lot more aware of the frequency of these types of problems if pets could talk.
You do have to be concerned about the possibility of other, more serious problems, in Cyndi's case, though.
Many older dogs have periodontal disease. This can lead to inflammation of the tissues around one eye and infection of the nasal passages on one side only. It can be difficult to confirm this as the cause of problems, even with clear evidence that periodontal disease is present. It is best in most cases to treat any obvious problems of the upper teeth when symptoms such as those you have reported are occurring.
Older dogs with drainage or blockage involving only one nostril may have cancer that involves only one side of the nasal passages or that is affecting the area around the nasal passages and the eye (the retrobulbar area). This is probably a little less common than teeth problems but has to be considered in a dog of Cyndi's age.
Once in a while we find a foreign body, such as a blade of grass or a small stick that is stuck in a nasal passage. It is possible to see these with an otoscope used to view the nostril, in some cases. In others it is necessary to consider an examination under anesthesia. This is the least likely of the problems I can think of, though.
Liver problems can lead to reddness of the scleras (the white portion of the eyes) but isn't likely to cause inflammation of one side of the nasal passages only.
It is a good idea to have Cyndi examined by the vet. For this type of problem it is not quite as important to be fully aware of the medical history as for problems that might involve her liver or heart. I think the relief vet will be able to help.
Good luck with this.
Oh --- the average temperature for dogs is 101.5 degrees Fahrenheit. We consider anything +/- 1.5 degrees to fall within the normal range -- so we don't get excited about temperatures from 100.0 degrees to 103.0 degrees in our office unless there are other supporting signs of illness.
Mike Richards, DVM 8/7/99
Immune system deficiencies and infections
Q: Well, Oliver no longer has psuedomonas but he has another respiratory infection caused by Enterobacter!!! I took him in for another endoscope and that is what they have found. His bronchi was very inflammed and they found a significant growth of this stuff. I realize it is a bacteria from the "gut" but can grow in soil, fresh water etc. What is the likely origin of it in his case - fresh water? soil? (we live right off of Lake Michigan in Chicago).
Could his immune system be weak? I asked the vet before and they gave me vitamins for him. I think I should ask them to check his various levels to find out what he is missing. The Specialist said that he may be lacking a sufficient amount of the requisite antibody that prevents trachial infections.
Can a dog's immune system get a boost and then be o.k. (e.g., give him shots of something for a while)? The breeder is very perplexed by Ollie's misfortune and finds it hard to believe that his immune system is "bad." Could it be that he had an infection early on (e.g., psuedomonas) that has either suppressed his system or stunted its full development?
Sorry to reach out again but it seems to never end. Also, we now have a two year old Vizsla and I am concerned about protecting all involved. Thanks.
A: Suzanne-
I am having a great deal of difficulty finding much information on Enterobacter species infections. The sensitivity test that usually accompanies bacterial culture will help in choosing an antibiotic so at least deciding on treatment options should be straightforward. I will continue to try to research this and see if I can give you more information later.
Immune system deficiencies do occur and it is entirely possible that this is a factor in the problems that Oliver is having. These can be very individualized problems and may be genetic but often seem to occur after severe infections based on the number of times that people notice that pets (and humans)just don't seem to ever recover fully after some infections. It can be very hard to definitively establish that an immune deficiency exists. In humans there are immune deficiencies that only occur in one family or in one area of the country or the world. It is often very costly to establish that these problems exist. In dogs it is rare that there is recognition of the possibility and enough available money to prove or disprove the existence of an immune system deficiency. In some cases of lung disease the immune system is inhibited by cilia that do not work properly or improper formation of the mucous lining of the bronchi and bronchioles.
It is probably more common for an underlying cause such as allergies to be the reason that infections recur easily. Organisms that normally can't manage to overcome the body's defenses and live in the respiratory system gain a foothold in tissue inflamed from allergies and then multiply and cause problems themselves. It is sometimes necessary to treat chronically for allergies and then to also treat infections as they occur.
Sorry I can't be more help.
Mike Richards, DVM
Pneumothorax refers to air accumulation in the chest cavity. As odd as this sounds, the chest cavity must have a vacumn (no air) to work properly. There should be no air pressure outside the lungs. This enables them to inflate when the muscle of the chest are relaxed and it expands. The air is then forced out of the chest by contraction of the muscle of the chest. When the lung is damaged and leaks air, it collapses the lung. The same thing happens when there is a hole in the chest allowing air in. Either situation can be the cause of pneumothorax after a traumatic even like being hit by a car. If there is only a small amount of air accumulated it can be reabsorbed. This is commonly the case with blunt trauma in which the lung ruptures, then heals itself quickly. If there is a lot of air or continuous leakage of air, it is usually necessary to place a drain in the chest to remove the air and maintain a vacumn. There are several ways of doing this to ensure continuous evacuation of air. We use a Heimlich valve (same guy as the Heimlich maneuver, I'm sure) attached to a silicon tube in the chest.
Mike Richards, DVM
Q: Dr. Mike- Hello. I am writing with a question about my dog's breathing/sleeping habits. He is a 1 1/2 year old spaniel mix and on three different occasions in the night I have woken up because he has made a funny choking noise -- when I check on him he doesn't seem to be breathing. It takes me a minute to shake him awake (he is a deadweight), but when he comes around he always seems fine and looks at my like I'm nuts. I am wondering if this is at all normal or could he have some sort of doggie sleep apena (sp?). He isn't on any medication except for when he has to go on long car trips. He is afraid of the car so we give him a mild tranquilizer perscribed by our vet. Should he get some neurological tests done? I'd appreciate any advice you might have. Thanks. N.
A: My first suspicion would be that this is some variation of snoring. Some spaniels snore so loud that it is startling to hear them at first. It is possible that there could be some upper airway obstruction, a soft palate problem (elongation or perhaps a cleft palate that has gone unnoticed). It would be worth asking your vet about this on your next visit or even to schedule a visit if the problem persists. It can't hurt to check around the pharynx and upper airways for problems.
Mike Richards, DVM
Q: We have recently acquired a female chow. She is of the smooth coat type, with a "heavy head". She is quite a beautiful dog, so I hope you can help me with this. The chow sounds constantly congested. She snorts and snores, and her normal breathing is generally raspy. Is this common for this type of dog or is there something we can do. I recently moved here and have not established a vet in the the area, how ever I have taken her to several breeders to see if they recognized the "noises", all to no avail. Thank You Very Much. R.
A: If there are heavy facial folds there may be some respiratory problems associated with them. Also, check to be sure her nares (nostrils) do not close shut when she inhales. This is more of a problem in smaller short nosed breeds like Boston terriers but it conceivably could happen in a chow. If so, it is usually possible to widen the opening surgically with pretty good cosmetic effects. She could have an infection or nasal obstruction for some other reason. Soft-palate elongation problems seem possible with the chow's conformation, too. It would be best to find a new vet and get an opinion on this condition. Most respiratory problems are a lot easier to treat early than they are to treat after secondary changes in the respiratory system occur. Mike Richards, DVM
Q: Dr. Mike I have a 7 month old pug who is happy, eating well and growing normally. When she exercises to the point of breathing heavily she has a (honking) cough and I can hear a single thudding noise in her throat each time she exhales. It sounds like flaps of skin hitting one another. Any ideas? Thank You, Judy
A: Judy- This is a guess, but I'd be most suspicious that your pug has very narrow nostril openings. When a dog that does not have adequate nostril width inhales, the nostrils are sucked shut and this can produce an audible sound similar to what you describe. In addition, this affects the rest of the respiratory tract as it attempts to apply more suction and you may be hearing a sound associated with that. If this is the problem it is amazing how much better these dogs feel after surgery to widen the nostrils. This can be done with good cosmetic results (pretty normal looking noses afterwards). This is definitely something you should discuss with your vet now, because allowing respiratory difficulties due to anatomical problems to go on chronically can lead to changes in the lungs and respiratory tract that are harmful and irreversible.
Mike Richards, DVM
Q: I have a woman friend whos' pet is suffering from fungal pneumonia. Can this lead to yeast infections in the dog and will there be a problem created in the immune system? Right now the animal is being treated with Sporenox. Any help you can be would be deeply appreciated.
A: I practice in an area in which fungal pneumonia is very rare. I am not familiar with the brand name Sporenox and will have to look it up tomorrow at my office to see if secondary yeast infections or immune problems are likely with its use. Mike Richards, DVM
Breathing difficulty in Bulldog
Q: We have a female Bulldog who lately seems to be panting heavily and breathing very rapidly,she is three months old and is very active.What could be the reason of this and what is the best solution?
A: Bulldogs have a lot of respiratory problems related to the shape of their face and head. They can have problems ranging from nostrils that are too small and collapse shut when they breathe to overly long soft palates that interfere with their larynx. They tend to get overheated very easily. We have seen a bulldog in our practice who got heat stroke while playing in an air-conditioned house! There is also the possibility that the problems you are seeing could be related to a congenital heart defect, although many dogs with heart problems have a decrease in activity level and you are not seeing that. Even an infectious disease like pneumonia could be causing breathing difficulties, although these problems also usually cause additional signs like depression or lethargy.
Your vet can help sort through the possible problems. In the case of the anatomically related airway problems it is sometimes necessary for your vet to refer you to a specialist for a definite diagnosis and treatment. Most vets are comfortable with surgeries to increase nostril size but not many are willing to take on soft palate reconstruction if that were necessary, for instance.
The first step is to let your vet know you perceive a problem and schedule a time for him or her to examine your dog. It may be very important to her health!
Mike Richards, DVM
Q: My nine year old yorkie recently developed hoarseness which seems to have increased. She was left in my car while I went to the library on Monday and barked hysterically the whole time - about 10 minutes. Since then it sounds like somebody is squeezing her throat and today (Saturday) it seems like she isn't eating her regular (dry) food. She is acting quite the same as usual, except for the barking. I should mention that she had a seizure last week (her fourth since birth) with no ill effects afterwards. Her health otherwise is fine. Please, can you give an opinion as to why this hoarseness is getting worse? I am taking her in tomorrow but she gets extremely agitated - lips turn blue etc. when she goes to the vet - I just hate to put her through some kind of dog laryngoscopy if it is probably just caused by the barking.
PS: There is no cough associated with this and she has been eating (like
also see Nasal Problems in Dogs
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...
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