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When our dog Casey was about nine or ten years old she started to slow down. Being a Chocolate Labrador Retriever she had always been full of energy, and chasing and retrieving Frisbees was her favorite game. Now she just didn’t seem interested anymore.
She’s getting old, I thought to myself. And of course felt sad. But I didn’t know that what I was seeing was actually one of the first signs of Laryngeal Paralysis.
Over the next year or two she didn’t always want to go out with our other dogs for a morning walk. Again, I just thought she was getting older.
She stumbled sometimes going up the stairs. Other days she seemed okay.
Over time she began to breathe loudly even when resting, and didn’t seem to want to do much other than sleep. We talked to her vet about it at annual checkups. Laryngeal Paralysis was mentioned, but was described as not yet a real concern.
Then last August, when she was 12-years-old, I took her out for a walk one morning. It was already warm and humid, but only about 9 a.m. and not bad yet. We got about halfway down our block when she stopped, started pacing, and collapsed on the road.
It was one of the most frightening moments of my life, as I watched her try to gasp for air but not able to breathe in. I petted her and tried to calm her. I truly thought she would die right there. After what seemed like forever but was probably a minute, she took in some wheezing gasps.
She continued to lie on the road with me petting her. I called my husband and he came with the car and picked us up. She was able to get up and seemed okay again before he arrived.
We took her to the vet immediately. Being a Lab, she got really excited to see the vet. Again, her airway closed and the vet tech rushed in oxygen for her. She was immediately scheduled for surgery. It was a Friday. She wouldn’t have surgery until Monday.
The vet told us to keep her calm, in the house, no activity, and keep the air on. So we lived in an icebox for the weekend, terrified she would stop breathing at any second.
This was the beginning of our Laryngeal Paralysis journey.
So what exactly is dog Laryngeal Paralysis?
What Is Laryngeal Paralysis?
Laryngeal paralysis, also known as Lar Par or LP, is a condition that interferes with a dog’s ability to breathe. It’s most common in middle-aged and older dogs, and also in larger breed dogs such as Labrador Retrievers, Irish Setters, and St. Bernards. However, LP can occur in dogs of any age or breed.
The larynx, also known as the voice box, is located in the neck.Its functions include controlling breathing and sound production, or barking. Cartilage flaps in the larynx cover the entrance to the dog’s trachea, or wind pipe. The flaps open when a dog breathes, and closes when the dog is eating or drinking to protect the airway.
A dog with LP has difficulty breathing and often sounds hoarse and raspy. The sound is sometimes described as “honking”.
When the larynx becomes paralyzed, the flaps can stay closed even when a dog is trying to breathe. It’s similar to having curtains sucked into an open window, blocking the airflow. If the paralyzed flaps are “stuck” in this shut position, the dog can suffocate.
You can hear many of these coughing and gagging noises in this Laryngeal Paralysis dog video.
What Causes Laryngeal Paralysis in Dogs?
In most cases of LP the cause is idiopathic (a fancy way to say the cause is unknown). A small number of cases may be caused by a tumor, trauma (such as a bite wound or surgery), certain diseases, or a congenital birth defect (the puppy is born with it). Congenital cases are most often seen in Bouvier des Flandres, Siberian Huskies, Bull Terriers, and Dalmatians. Clinical signs are often seen early on with these breeds.
Most cases are believed to be caused by a neuromuscular disease, and laryngeal paralysis is one of the first symptoms.
As the disease progresses the dog may also develop neurological symptoms in other parts of the body, especially back leg weakness.
A fairly new term used to describe the disease in older dogs showing neurological symptoms is geriatric onset laryngeal paralysis and polyneuropathy (GOLPP). This is the fancy term for older dogs who have the traditional signs of Laryngeal Paralysis plus the progressive hind end weakness that accompanies it. This is technically what Casey has. GOLPP is progressive, and there isn’t a cure.
GOLPP dogs with hind end weakness slowly lose thigh and back muscle mass, often scuff or drag the tops of their paws when they walk, having trouble climbing stairs, getting into a car or up on furniture, and are easily unbalanced on their back legs. Physical therapy and some supplements and medications can help dogs with hind end weakness.
The weakness in the hind limbs progresses at different rates in dogs, just like the onset of the disease.
In addition to the leg muscle weakness the esophagus (the tube that carries food from the throat to the stomach) becomes flaccid and dilated, a condition called megaesophagus. The esophagus moves food more slowly than normal, allowing food to “pool” in the esophagus and stretch it. This can damage the nerves and lead to increased aspiration pneumonia.
Dogs with LP are 21 times more likely to develop megaesophagus than dogs without it.
Despite all of this, the good news is that the average LP patient is at least 10 years old and the progression of the hind end weakness is fairly slow. That means that many dogs can live their normal lifespan before further neurological weakness becomes a problem.
Signs of LP
Each dog progresses at their own rate with LP. There may be a fairly quick curve of a matter of months between noticing symptoms and the dog having more issues. It may also happen slowly, as it did for Casey, over a period of years before the symptoms become a clinical problem.
You may not know something is wrong. You may notice your dog has noisy panting or breathing.
- You notice your dog tires more easily after play or walking
- Your dog’s bark may change and become raspier
- Your pup may cough or gag when they eat, or when they’re winded after activity
- Your dog may pant excessively, even when cool or not active
- Coughing and gagging symptoms during eating or drinking may increase, or occur more often throughout the day without eating
- Your dog may no longer want to play or go on walks
- Your dog may have loud, ragged breathing during activity
- Your dog’s airway may become blocked during exercise
- Hot, humid weather makes the condition worse
- You may start to notice hind end weakness in your dog
How is Dog Laryngeal Paralysis Diagnosed?
Your veterinarian will listen to your dog breathe and ask you about his or her history.
If you’ve noticed any of the symptoms listed above, or other similar symptoms, make sure to tell your vet.
A sedated exam of the larynx using a scope may be needed, especially if the vet thinks your dog will require surgery. Your veterinarian may also take x-rays of the neck and chest and complete blood work to rule out other possible causes.
If your dog is exhibiting severe symptoms, or if they are less tolerant to anesthesia, your veterinarian may discuss doing the exam immediately followed by the surgery. That way your dog only needs to go under anesthesia once.
Laryngeal Paralysis Treatment Options
The treatment options for LP are either trying to control symptoms non-surgically for milder cases, or surgical treatment for more advanced cases.
Let’s look at non-surgical options first.
Non-Surgical Options /Alternatives to Surgery for Laryngeal Paralysis
In some cases a dog may not be a good candidate for surgery. Pre-existing medical conditions, advanced age, inability to tolerate anesthesia, or other factors may mean your dog would do better with non-surgical management.
So how can you help a dog with Laryngeal Paralysis?
If your dog is exhibiting milder symptoms, LP can often be treated with medication and by modifying risk factors.
Medications such as mild sedatives, anti-inflammatory drugs, and antibiotics may help. Sedatives are used to help calm your dog so they don’t become overly anxious about their breathing. Anti-inflammatory drugs can help reduce swelling in the throat caused by coughing, which could make breathing more difficult.
Some dogs are given an anti-anxiety medication called Doxepin. Doxepin is an anti-depressant drug, as well as a strong antihistamine. It’s been used in humans to treat depression and anxiety.
The research on Doxepin for Laryngeal Paralysis is still ongoing, but many owners of dogs with mild to moderate symptoms find that it helps diminish breathing difficulties in their dogs and helps with the anxiety caused by difficulty breathing. Doxepin must be prescribed by a veterinarian and would be taken for the rest of the dog’s life if they didn’t have surgery.
Other Alternative Treatments To Manage Mild LP
Your veterinarian will probably also make other recommendations such as:
- Avoid hot and humid environments which can make breathing more difficult
- Avoid strenuous exercise
- Don’t ever put a collar on your dog; use a harness instead to reduce pressure on the larynx
- Maintain a healthy weight. Extra body fat limits the room for lung expansion during breathing, increases the workload during exercising and the intensity of breathing, and makes dogs more prone to overheating
- Contact your vet if there are any changes in your dog’s breathing
Environmental modifications can also help. In addition to keeping your home cooler, you can provide a fan on a gentle setting in warmer months.
Some pet parents find that providing special cooler bedding options, such as a cooling dog bed or an elevated dog bed can help. These can be particularly good options for thick-coated dogs like huskies or golden retrievers.
If your dog is younger, or older but in otherwise good health, and their symptoms are moderate to severe, your veterinarian will probably offer surgery as a good (or in some cases the only) option to save your dog’s life.
Laryngeal Paralysis Surgery Options
There are several surgical techniques available, but by far the most common is a procedure called arytenoid lateralization by tie-back, often just know as tie-back surgery. This is the kind of surgery Casey had. In this procedure one side of the collapsed cartilage in the larynx (usually the left) is sutured (or tied-back) to prevent it from collapsing into the airway when the dog breathes.
This surgery will often drastically improve the dog’s quality of life, but doesn’t restore the larynx to normal functioning.
The airway can’t ever be normal again, as one side will be permanently sutured open. The biggest drawback of that is the dog risks having food or water go down into their airway. When that happens the dog can develop aspiration pneumonia, or AP.
Another common side effect is a voice change that’s often permanent.
Casey’s bark is now much quieter and a little raspy, but it doesn’t stop her from enjoying a good bark fest with her brothers:)
How Much Will Laryngeal Paralysis Surgery Cost?
According to Embrace Pet Insurance, the average Laryngeal Paralysis surgery cost is $2600-$5200 for a tie-back.
The cost of Laryngeal Paralysis surgery varies by how sick your dog is before surgery, post-surgery recovery and complications, and how experienced the veterinarian is.
The Laryngeal Paralysis tie-back operation is complex, so make sure the veterinarian performing the procedure has a lot of experience at it or is a veterinary specialist in this area.
Laryngeal Paralysis Tie-Back Surgery Complications
The typical complication rate for tie-back surgery is reported to be about 10-15%. About half of those cases did well after treatment.
Some of the complications from tie-back surgery can be blood clot formation, pain with swallowing, irritation of the lining of the throat, and coughing after eating and drinking.
As mentioned above, aspiration pneumonia is a major possible complication, occuring in up to 24% of dogs after surgery. Because one side of the larynx is permanently open, the dog can inhale food, water, or other material into their lungs leading to pneumonia.
One of the most serious complication is a tearing of the tie-back sutures through the cartilage it’s attached to (the technical term is avulsion). This can happen as a result of too much barking after surgery.
Another cause of tearing is that some older dogs have hardened cartilage that doesn’t hold a suture well. This was one of the complications Casey’s vet warned us about due to her age.
Either one of these causes of tearing of the sutures results in failure of the surgery and means the airway is blocked again, which is a medical emergency. This is why it’s so important to monitor your dog after surgery for changes in their breathing.
If a tear happens, the surgery can be repeated on the other side of the larynx.
I’ll give you a personal account of how all this worked for Casey. Her case was pretty typical. Of course, your veterinarian may have other instructions that vary from these, so be sure to follow them.
The night before surgery Casey had dinner as usual. She couldn’t eat anything after 10 p.m.
Day Of Surgery
Casey couldn’t have breakfast the morning of surgery but could have water. For those of you in multiple pet households, you know lack of breakfast is a tragedy to a dog (especially a Labrador!). I took Casey outside and brushed her while the other dogs had breakfast. Then it was off to the vet.
Once we got there, the vet went over the procedure with us. Since Casey had almost died in her office during the last visit, she hadn’t had a scope done to confirm the LP. The vet said once Casey was under anesthesia and the issue was confirmed, they would go ahead with the surgery.
We had to sign paperwork and provide a credit card. It was in the range discussed above, about $3500. The vet said they would call when surgery was done.
Immediately After Surgery
When the vet called luckily all had gone well. She said that at the end of surgery when they attempted to pull the oxygen tube out of Casey she fought it because she loved having the oxygen so much. This of course made me feel super guilty because all this time she hadn’t been getting enough oxygen and I didn’t even know it. I was just relieved surgery went well.
Casey spent the night in the hospital to keep her quiet and for observation.
We picked her up the next day. The left side of her neck and chest were shaved and she had a large bandage over the area to keep the sutures clean.
Casey the day after laryngeal paralysis surgery
The main instructions from the vet included:
- Monitoring her for any change in her breathing
- Watching her attitude, appetite, urination and defecation
- Alerting the vet if she became depressed or stopped eating (which could be a sign of aspiration pneumonia)
- Monitoring her incision for redness, swelling, pain, or discharge
She was sent home with a loose fitting Elizabethan collar (you know, the one that looks like a lampshade) to prevent her from scratching the incision. The vet said the bandage could be removed in 3-5 days, but it got loose and came off after a day or two. We checked and this wasn’t an issue.
About a week after surgery, Casey started to seem a bit more lethargic. She also seemed to be coughing more that evening. This all happened very quickly, within a matter of few hours.
So, off we went for another trip to the emergency vet. After an inconclusive chest x-ray at midnight, a case of early aspiration pneumonia was suspected. A two-week course of antibiotics cleared it up, and she was back in business.
She was sent home with Meloxicam (a non-steroidal anti-inflammatory drug) and Gabapentin (a pain reliever). Both of these drugs are common after surgery to help reduce swelling and relieve pain. They’re easily mixed into wet food.
Feeding After Surgery
This was one of the most scary parts of the after-surgery instructions, and is for most people. It’s not hard, you just obviously don’t want your dog to choke or inhale food. Don’t worry – they actually do really well at figuring out a new way to eat!
We needed to feed Casey canned food, which she loved. We were told to feed per the instructions on the can, which meant about 4-6 cans of food each day for a large dog. So stock up before you bring your pup home from surgery.
Casey needed to be fed 3-4 meals per day, dividing the cans up among those meals. Her medication was hidden in the food.
I made human meatball sized pieces of the dog food for each can. I put all the meatballs on a plate, and placed one on the floor at a time for her to eat.
Again, Labrador! She swallowed them whole in one gulp and stared at me for more. I waited about 10-15 seconds between each meatball just to make sure she had swallowed it and didn’t gag.
I followed this routine for two weeks. After a follow up with the vet, she said we could begin to add kibble into canned food over time, and give kibble soaked in water if she was doing well.
Feeding After Recovery
What Do Dogs Eat After Surgery?
Casey loved having all canned food so much that we just switched her to completely canned. She eats it out of a regular bowl and has no problem with it now. Some people eventually return to dry kibble without any issues.
Since the surgery, and I think because she’s eating canned food with a high water content, Casey doesn’t drink water out of a bowl much anymore. The first few times she did drink after surgery were again nerve-wracking! But she did really well.
She did cough and gag a little with it at first as she learned how to swallow with her airway open, but most dogs figure this out pretty quickly.
What Kind of Bowl Should I Use?
Some people are advised to use a raised feeder with their dog after surgery to reduce the risk of aspiration pneumonia. Our vet advised us to continue feeding Casey with her bowl on the floor as long as she did well with it, and she has.
I personally think it’s harder for her to eat and drink with a raised bowl because her throat is at the same level as the food and the risk of aspiration would be higher. Again, this is a decision for you and your vet, and most importantly what works best for your pup.
Some dog owners find it helpful to switch to a slow feeder bowl, especially for dogs who love to gulp their food. These bowls usually have raised ridges or patterns that make the dog nose around and work to get the food out. They’re available in models that sit on the floor or as inserts for raised feeders.
Acid Reflux After Surgery
Casey had some discomfort at night after surgery, gagging often when she layed down. She also wanted to eat more grass, which is discourage due to the possiblility of aspiration. Her vet had us put her on acid reflux medication just like people take. She currently takes Omeperazole morning and night with her food and doesn’t have these issues anymore.
If you notice your dog having more issues with this before or after surgery, make sure to talk to your veterinarian about the posssibility of reflux.
Limited exercise was recommended for 4 to 6 weeks. We needed to keep her in a climate-controlled environment (ie in the house with the air conditioning on since it was summer).
When we did take her for a walk after her second-week post-op, it was to be a cooler time of day such as very early morning or later in the evening.
Barking was highly discouraged since it could affect the surgical site by popping the stitches or causing inflammation in her throat.
- Casey couldn’t play with other dogs
- She needed to be kept confined when not supervised
- Walking was the most strenuous activity she was allowed
- She had to be walked on a leash outside for potty breaks only
- She was discouraged from doing stairs, but could go up and down stairs only when necessary and only under our supervision
- No jumping, running, or playing
Okay, so a lot of that was hard because, hello, Labrador! And not only that, but a Labrador who hadn’t been able to breathe well in a long time was now getting oxygen. But we made it through okay.
Casey was allowed to go for a 10 minute walk on a leash and harness. All other restrictions still applied.
Weeks 4+/Life After Surgery
Casey’s walks were increased by 5-10 minutes per week, depending on her tolerance. We were told we could work up to 45 minute walks, but at her age she tops out at about 20-30 minutes.
Roughhousing was still discouraged until after six weeks, but being 12 years old meant she didn’t wrestle as much as she used to.
Other restrictions for life remained. These included not exercising in very hot and humid weather, maintaining a healthy weight, no collar (just a harness for walking), and preferably no swimming.
We thought the no swimming thing would be a big problem because Casey loved swimming her whole life. But strangely enough, she doesn’t have any interest in the water since surgery.
Swimming is considered dangerous because the dog isn’t able to shut off their airway any longer after surgery, and could get water in their lungs leading to aspiration pneumonia. Some dogs return to swimming anyway and do fine with it.
Laryngeal Paralysis – When To Euthanize
While this is obviously very painful for pet parents to think about, there are cases where euthanasia of a dog with GOLPP or Laryngeal Paralysis is the most humane option.
In cases where the dog is very old, has other medical conditions that are severe or terminal, cannot tolerate anesthesia, or is otherwise not a good candidate for surgery, putting the dog to sleep may be the best option for the dog.
And although we wish it wasn’t a consideration, the cost of the surgery is very high, in the thousands of dollars. Some people simply can’t afford to pay that much. In severe cases of LP when the money isn’t available, it seems far more humane to not make the dog suffocate to death when they could be put down painlessly with their family near them.
Casey is now 13, and almost a year post surgery. She is back to enjoying walks around the neighborhood, and while she puffs a bit louder than she did as a young dog, she does just fine.
Her left rear leg occasionally gives out for a step, some days worse than others.
She enjoys sniffing everything, and just actually being able to breathe. Some days she even catches a few Frisbees thrown to her:)
She loves to travel, and we’ve actually taken three long road trips with her since her surgery. She gets super excited each time she sees us packing the car.
Our veterinarian has given us a prescription of antibiotics to take with us when we travel since we aren’t always near an emergency veterinary hospital.
We know her sounds and behavior very well, and can tell right away if she seems to be starting a case of aspiration pneumonia. So far she only had one after surgery, but starting the antibiotics right away and getting her to a vet for a chest x-ray, even on vacation, is the best way to keep AP from advancing very quickly.
We know that she’s getting older, and that this won’t last forever. But just watching her actually enjoy being a dog again, and not having to struggle just to breathe, has made everything worth it.
We really haven’t had to make many changes for her or us. We do keep her walks short and slow if the weather is very warm and humid.
We keep the house at a reasonable level of air conditioning in the summer. She now walks with a harness instead of collar (which your pup can’t wear anymore after surgery due to not putting stress on the windpipe).
Canned food is now on her dinner menu, although many families may be able to eventually go back to dry kibble or kibble that’s soaked. If you cook at home or use a dog fresh meal service that works great as well.
I know that not all outcomes go as well as ours did, and we were lucky. Casey didn’t die on the road that day, she was a good candidate for surgery, and we had a wonderful and experienced veterinary surgeon. We were also able to pay for the surgery, which definitely wasn’t cheap.
If you’re reading this after just starting your Lar Par journey, I wish you and your pup all the best.
Because for many dogs with Laryngeal Paralysis, whether they have surgery or alternative treatments, there are still many adventures for you to share!
Has your pup been diagnosed with Lar Par? Questions or advice for pet parents? We’d love to hear from you!