Rusty and Laryngeal Paralysis
Rusty is a new patient. As of the writing of this report, he has only had three treatments. At his initial visit, Rusty was eleven years of age. He had a history of food allergies, atopy (inhalant allergies), and bronchial asthma. This past year, at the beginning of the recent monsoon season, his breathing pattern changed, panting loudly, and gasping for air. The more he moved, the harder he breathed, and the more distressed he would become. Based on clinical history, physical exam findings, symptoms, breed, and age, Diagnosis: Laryngeal Paralysis.
Because decreased nerve function in the laryngeal area is the cause of the paralysis, there are no “medicines” that will correct it. Instead, initial treatment involves lifestyle changes that include reducing activity, decreasing stress, and decreasing the anxiety. Dogs with severe distress need surgery. The most common surgery is best described as a “tie-back” of the vocal folds, opening up the vocal folds. Unfortunately, the surgery does not come without complications. Aspiration pneumonia is the most common complication. All treatments were discussed, including surgery.
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What is laryngeal paralysis?
Laryngeal paralysis occurs when the abductor muscles in the larynx (voice box) are unable to expand and keep the voice box open. Although any breed can be affected, the problem is most prevalent in older large breed dogs. The most common breed is Labrador Retriever. In patients with laryngeal paralysis, the vocal folds in the voice box move weakly and obstruct the voice box and make difficult to take a deep breath. The disease does not occur suddenly. There is usually a long history of panting and decreasing levels of stamina. Most will breathe more loudly than their housemates. The dog’s voice will also change. As the vocal folds become more and more flaccid, the inability to breathe becomes more severe, the patient develops anxiety, leading to increasing levels of respiratory distress and gasping.
Although direct visualization of the vocal cords under sedation is the necessary to make the definitive diagnosis of laryngeal paralysis, most clinicians make the diagnosis based on breed, clinical history, and physical exam findings.
Eastern: Lung Qi Deficiency
Rusty’s acupuncture treatments focused on increasing Lung Qi, opening up the airways, eliminating the Qi and Blood Stagnation in the laryngeal area, tonifying the Wei Qi (Defensive Qi), and supporting the muscles and nerves in the area. From the Eastern perspective, the loss of nerve and muscle function is related to decreasing levels of Spleen and Kidney Qi. The herbal formula, Bu Fei San was prescribed at his second treatement to help increase lung function.
Rusty showed improvement immediately after his first treatment. The improvement was short lived, lasting only two days. With each subsequent treatment, the patient exhibited decreasing levels of distressed breathing. At his sixth treatment, the owner reported Rusty had more stamina.
At the sixth treatment, we added Doxepin to his medications. In some laryngeal patients, the medication eases breathing. At his eighth weekly treatment, the owner was very happy. She reported significant decreases in his anxiety, his labored breathing, and the abnormal breathing sounds. When relaxed, the sound of Rusty’s breathing was almost normal. At one point, she thought Rusty had expired, he was making no sounds while he wa sleeping.
Of course, Rusty is still having breathing issues when he is excited. The structural problem remains, it is not “fixed”. However, our initial goal of our treatment has been met, we have decreased his level of discomfort and anxieity. We have extended his treatments to every two weeks and will monitor his response.