Petunia

I received this question in the mail the other day:

Dr. Herndon I own two pugs and one is a rescue I have had for two years. She has tracheal collaspe and is roughly 10 to 12yrs old. She has other health issues such as PK of the eyes, arthritis, fx vertebrae with disc herniation and mildly enlargerd heart. I was wondering what treatments would be considered to help decrease the consistent coughing and ease her breathing so she isn't working so hard just to take a simple breath. And what other insights do you have on this condition in dogs.

The first thing I have to say about Miss Petunia is WOW! Sounds like she has more than her fair share of stuff to deal with!

Let's take these issues one at a time, shall we.

1)Tracheal collapse: This is a condition where the trachea forms in a more flattened shape instead of a more circular/rigid form. As a result, the top of the trachea (which under normal circumstances is a thin band of flexible tissue) is much wider and "floppier" than usual. When you breathe in, physics says that the air pressure decreases and that floppy ceiling waggles in the breeze. At times it can actually flop all the way down and "snap" the trachea shut for as split second. Collapsing trachea will worsen with age as that floppy ceiling gets stretched and inflamed over time. These guys usually cough quite a bit - ESPECIALLY when they are excited or exercising (your breathing rate and speed increases and that makes the collapse worse).

2) Pigmentary Keratitis (PK): This means that the cornea gets covered in pigment. Instead of a clear front to the eye, you instead end up with a dark, sometimes black, covering to the cornea. These guys are functionally blind. It's like wearing black sunglasses.

3) Fractured verterbra and herniated disk: This means that one of the backbones has a break and the disk between the two is bulging up into the spinal canal. This probably means that she is 1) in chronic pain and 2) probably has some difficulty moving her back legs in concert with the rest of her body. Neither of those have to be true, but they probably are.

4) Arthritis: This is a general term describing wear and tear on the joints. "Degenerative Joint Disease" is another term. We all get some degree of arthritis in our joints at some point.

5) Mildly enlarged heart: Exactly that. There is probably some degree of heart disease and that has caused the heart to change shape a bit and "stretch out." There probably isn't any overt failure, but the heart is showing some changes. Fairly common in older individuals. As it enlarges, the heart will push a bit on the airway where the trachea splits. This can cause cough as the heart beats and tickles the trachea and bronchi. Cough due to this is usually worse when the patient is lying down, ESPECIALLY when lying on the back.

See what I mean? She's got lots of issues! So now what?

PK - steroid drops in the eyes can help slow it down, but once advanced, there's not much to do.

Arthritis - Use a combination of therapies. Glucosamine, Adequan, pain medications (NSAIDS, narcotics), acupuncture and/or chiropractics.

Heart - if no evidence of failure, my opinion is that we do nothing. There are arguments on whether certain medications can slow progression of disease. Unless there is overt failure, there isn't any need. HOWEVER, omega-3 fatty acids (fish oil) have been shown to do all kinds of wonderful things for the body including slowing progression of valvular heart disease. Best thing is that fish oil ain't gonna hurt a thing.

And now we're back to the collapsing trachea. Narcotics are a great choice to stop the kind of irritation and automatic cough produced by a collapsing trachea. Tramadol is narcotic-like and has the benefit of being cheap and easy to get. Tramadol would provide multiple kinds of help for her! It would provide pain management for her back and would have the added "side effect" of helping the cough. By far and away my favorite cough medication for dogs is hydrocodone/homatropine (Tussigon, Hycodan). The stuff usually works miracles on collapsing trachea. But it is controlled (meaning the DEA keeps track of it and there is more paperwork involved), more expensive, and at times has gone on backorder and been impossible to find. Tramadol is a great substitute but doesn't always work quite as well.

Narcotics are used several times daily - sometimes as frequently as every 4 hours, but we try to use them when necessary and no more than twice or three times daily. What we are trying to do with cough medications is keep obnoxious coughing fits under control. Not eliminate the cough all together.

Steroids (like low dose prednisone or a combination drug like Temaril-P) may help and may be necessary from time to time. HOWEVER, you CAN NOT use steroids at the same time you are using a NSAID (like carprofen) for the arthritis. So you and your doctor will have to decide which is more important and pursue that course. Steroids aren't something we should use long-term either, so again, you have to weigh the risks and benefits with your veterinarian.

In Petunia's case, it sounds like Temaril-P and Tramadol may be a good combination when things are bad. Tramadol alone may be enough. The thing with these guys is that there is no one answer. We have several different arrows in the quiver and we just have to see which one comes closest to the bulls-eye.

We also need to limit her "excitement." We don't want to go on long walks, don't want to chase the ball. Use her symptoms as a gauge of your exercise limits. When her symptoms worsen, you have to back off the activity. Obesity and pugs often go hand-in-hand, so some activity is a good idea, but we don't want to force her over the edge.

One note on PREVENTION of pug respiratory problems. Pugs are prone to having excessively narrow nostrils and long soft palates. If you have a young pug (or puppy) and they snore and snort too much - talk to your veterinarian about having the nostrils fixed or the soft palate trimmed. Opening up the airway takes a LOT of pressure off the trachea and palate and can DRAMATICALLY improve symptoms. Constant pulling against narrow nostrils can stretch out the soft tissues and make everything WORSE!! Now they tire quickly, have trouble breathing, can't exercise, get fat, have even more trouble exercising and it's damn near impossible to fix it after everything is collapsing! If your veterinarian says the nostrils are too narrow - it's worth EVERY PENNY to have them worked on. I'll post more on that later.

AMH