Wooo-wee it’s hot!

Summer is fast approaching, yaay! So are summer emergencies, boooo.

Wooo-wee it’s hot!

Summer is fast approaching, yaay! So are summer emergencies, boooo.

Dogs and cats are usually safer in the winter months due to less exposure to other animals, less outdoor activities, and when it is cold outside most owners like to hibernate in their warm houses cuddled up with their pet.  More HBC’s occur in the warmer months, ACL tears from playing or chasing squirrels up a tree, more interaction with potentially dangerous wildlife (depending on your area snakebites are more likely), and accidents with pools or lakes (drownings).  Also common in the summer months is a problem called laryngeal paralysis.

• Laryngeal paralysis (Lar par) occurs when the nerves and muscles that control the movements of one or both arytenoid cartilages of the larynx gradually weaken to the point of failure.

• Common breeds for Lar par are older larger breeds such as, Labrador Retrievers, Golden Retrievers, Saint Bernards, etc.  Although any breed can be affected even cats! Some animals can even be born with a congenital laryngeal paralysis, in general it has been found to be inheritable in several breeds (Bouvier de Flandres, Dalmatian, Bull Terrier, Siberian Husky and Siberian Husky mixes).

• The usual scenario is a phone call from a perplexed and concerned owner that “Hershey” their chocolate lab has been panting incessantly for almost an hour after regular activity outside. Often, but certainly not always, our canine friend “Hershey” could stand to lose a few pounds and it is probably mid-August with the temperature outside in the high 80’s. The extra weight and hot weather did not cause the laryngeal paralysis it simply exacerbated the already present condition.

• Upon presentation the patient may already be in respiratory distress so it is essential to triage them right away. If the patient is compliant a pulse oximetry reading would prove helpful in this case along with assessment of the mucous membranes. A correct respiratory rate may be an impossibility with the amount of panting that is going on.  Controlling the patient’s temperature is also very important in order to decrease the stresses that hyperthermia has on the body and of course the excessive panting that goes on in an attempt to cool the body.

• If your patient is more critical (cyanotic, obtunded, or non-responsive) immediate and careful intubation would be necessary.  Intubating a patient with laryngeal paralysis can be tricky due to inflamed tissues from the excessive panting making the airway smaller. Think English Bulldog and pick a smaller endotracheal tube than you think you will need. (Very similar to tracheal collapse in your super-small patients. Yorkies, Maltese,Pomeranians).

• Aha! My patient is now pink and stabilized on oxygen via an endotracheal tube. Ummm…now what? Well, it would be really great to just keep your patient happy on oxygen, but obviously that is not a practical situation. Somehow you have to get them off that tube without them turning purple again.

• By this time your patient has received loads of supportive medication and fluids to stabilize him which will also help you to now get him off the tube. Some patients can be gradually weaned off but left in a sedated state after extubation to decrease the panting and swelling in the throat. The goal is to eventually discharge the patient so arrangements can be made for laryngeal tie back surgery.

• When all efforts to wean fail: If your facility does not have a surgical suite ready for such a procedure you will need to refer out to an emergency hospital. Getting from point A to point B with an oxygen dependent patient will not be easy, but hopefully your hospital has at least one portable oxygen tank, a spare driver, and someone to monitor the patient en route. (If oxygenation is not a problem a regular Ambubag should suffice.)

• Most patients do very well with corrective surgery of either a unilateral or bi-lateral arytenoid lateralization.  They may lose some or all of their bark, but will no longer be at risk for trouble breathing due to the arytenoid cartilage.