Dr. Phil Zeltzman’s Blog

We used to believe that laryngeal paralysis was a standalone condition. Recent research shows that it’s a bit more complicated. Laryngeal paralysis is a disease of the nerves (poly-neuropathy) that can sometimes affect other body parts besides the larynx (voice box).

What is GOLPP?

To better describe this complicated disease, it was named Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP in short). GOLPP slowly gets worse over time. It affects dogs developing signs of upper airway obstruction or blockage.

It has been observed in older or geriatric dogs, particularly in Labrador retrievers and other large breed dogs. We now understand that there are 3 main parts to this disease.

* 1st condition: laryngeal paralysis

Affected dogs are most often brought into the hospital because of signs associated with laryngeal paralysis, because it’s the most obvious one and can be life-threatening. It causes dogs to have difficulty breathing, to the point that they can suffocate.

For more information on lar par, click here: Laryngeal paralysis is not a death sentence

* 2nd condition: mega-esophagus

Further questioning may reveal “spitting” up food, sometimes mistaken as vomiting (which is very active, ie lots of effort).

Because there is no effort involved, the condition is called regurgitation. It is due to a malfunction of the esophagus, which is the tube between the mouth and the stomach. It becomes extremely distended (mega-esophagus) and food simply piles up inside, instead of going down into the stomach. When the amount in the esophagus is too much, it’s expelled effortlessly via regurgitation.

This increases the risk of aspiration pneumonia since these dogs have trouble protecting their airways and lungs.

* 3rd condition: back leg weakness

In addition, some dogs develop weakness in their back legs. Sadly, it is often inaccurately blamed on arthritis or old age.

In reality, it really has to do with the same nerve condition. The legs are not well coordinated, and the muscles get weaker over time.

Which breeds are affected by GOLPP?

Most of the research has been done in Labradors. We know for a fact that Labs can get GOLPP. Some authors say that they all get it eventually. I think that it’s a bit more nuanced than that. I don’t think they all get it.

The condition has also been diagnosed in other purebreds and mixed breeds, but there isn’t as much research about them.

What is the treatment of GOLPP?

There is no cure for GOLPP, but there are ways to help each one of its components.

The gold standard to treat laryngeal paralysis is surgery (called a tie back). In good hands, i.e. typically those of an experienced board-certified surgeon, it provides good results as it allows the patient to breathe and function. Despite possible complications, surgery dramatically increases both lifespan and quality of life.

There is no treatment for megaesophagus per se. The dog needs to be fed soft to liquid food, then remain upright for 15 minutes after each meal.

Dogs with weak back legs benefit from slow leash walks and physical therapy to strengthen the muscles.

What should you do if your dog has GOLPP?

As a surgeon who deals with laryngeal paralysis & GOLPP frequently, this is what I tell my clients. Other surgeons may disagree, so please understand this is my personal & professional opinion, based on years of experience.

The best way to help a dog with laryngeal paralysis is surgery (a tie back). Suffocating is a horrifying way to live. Of the 3 different components of GOLPP, lar par is the one that affects quality of life the most, and the only one we can “fix.”

So my (again, personal) philosophy is: fix what can be fixed, and be ready to deal with what cannot be fixed (megaesophagus and weakness). It’s not for everybody. It requires serious love and dedication.

If the dog has megaesophagus at the time of the diagnosis, it still may not preclude performing surgery. It definitely increases the risk of aspiration pneumonia, but several of my most dedicated clients have helped their dogs successfully.

If the dog has a weak backend, at least this part is not life-threatening in the short term. With proper exercise and physical therapy, we can still help these dogs. And chances are, once a weak dog finally gets more oxygen, (s)he might get stronger after a tie back.

Ultimately, by putting together the right treatment plan and the right team, which includes a very loving and dedicated pet owner, affected dogs can maintain a good quality of life.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

“Bloat” is also called many different things: twisted stomach, Gastric Dilatation Volvulus (GDV), gastric torsion, stomach torsion etc.

Side note: it’s unfortunate that we (vets and dog owners) have gotten used to calling it bloat. After all, bloating is not a big deal in people. Yet “bloat” can kill a dog in a matter of hours.

Vets sometimes tell pet owners that we don’t really know what causes GDV, and therefore we don’t know how to prevent it. However, that is not exactly accurate…

Here is a summary of the main known causes.

1. Breed

Large and giant dog breeds are at risk for GDV, including Great Danes (the #1 breed), German shepherds, Weimaraners, St. Bernards, Dobemans and Old English sheepdogs. These breeds are roughly 25% more likely to get GDV than others.

A few smaller breeds, such as basset hounds, boxers, and standard poodles can also be prone to GDV.

2. Conformation

Conformation has to do with the shape of a dog.

Dog breeds called “deep-chested,” have a tall chest and a skinny belly. Think of a Great Dane. A deep chest, combined with stretching of ligaments that attach to the stomach, increases the chance of stomach torsion.

3. Genetics

Dogs with a first-degree relative who had GDV are at greater risk of getting

it themselves. This chance increases by 20% with each additional year. These factors confirm that GDV is a partially genetic disease and dogs at risk should be spayed or neutered.

In addition, better selection should be taken seriously by breeders.

4. Stress

Stressful situations can also contribute to a twisted stomach. Boarding, thunderstorms, moving, vet visits and hospitalization are all potential triggers for nervous dogs.

One study showed that having a high-stress environment or being fearful contributed to GDV compared to similar dogs who were in a non-stressful environment.

5. Feeding

Eating fast, and how often dogs are fed, have been shown to increase the risk of stomach torsion.

Therefore, if your dog eats fast, it’s important to find ways to slow it down. There are special bowls made for that purpose.

In addition, dogs fed once per day are more likely to have GDV, compared to dogs who are fed 3 times daily. Several small meals throughout the day are better for dogs at risk.

6. Food

Believe it or not, studies have shown that moistening dry dog food before feeding actually increases the risk of GDV in large-breed dogs.

Ironically, feeding a dry-only diet has also been shown to increase risk.

So what’s a concerned dog owner to do?

Recommendations have been made to help prevent a first episode by avoiding exclusively dry, expanded, cereal-based, or soy protein-based commercial dog foods.

Feeding a combination of dry and canned food together may be a way to lower the chances of GDV. I insist: “may be a way.” There are no guarantees here, only ways to try to lower the chances.

Also, foods with fat listed among the main 4 ingredients have been shown to increase the risk of GDV. So please look at the list of ingredients on your dog food.

7. Water

It is recommended to avoid drinking large amounts of water before and after exercise.

Ironically, too little water before and during meals may increase the chance of a dog suffering from GDV! A recurring “hot story” about ice water causing GDV regularly shows up online and appears to be a complete hoax.

8. Exercise

A fairly classic recommendation to reduce the risk of stomach torsion is to avoid heavy exercise 1 hour before and 2 hours after eating a meal. The idea is that it’s easier for a stomach to twist when it’s full compared to when it’s (partially) empty.

9. Age

Even though I always say, “age is not a disease,” age can play a role in a dog’s risk for stomach torsion.

In Great Danes specifically, age is a very important risk factor for GDV.

One of the reasons may be the stretched ligaments, over time, as mentioned above.

10. Other risk factors

There are countless other risk factors that are unproven, controversial, or contradicting.

. For example, some studies show that a raised bowl is better to decrease aerophagia (aka swallowing air), while others imply a bowl on the floor is ideal.

. The at-risk gender varies from study to study.

. The month, the cycle of the moon, and a previous spleen removal are also fuzzy risk factors.

• Gastropexy

This last point is not a risk factor – on the opposite, but it’s important to mention here.

A gastropexy, or tacking the stomach to the inside of the belly, is a simple surgery that can prevent twisting of the stomach. In good hands, it’s successful over 95% of the time.

Importantly, it prevents twisting of the stomach, not true “bloating” – aka the stomach getting full of air – we don’t know how to prevent that and it remains a risk for life.

The gastropexy or “pexy” in short is part of the surgery to treat GDV. But it can also be done preventively, or prophylactically. So it’s called a prophylactic gastropexy.

For example, Great Danes have a 40 % chance of having GDV in their lifetime. Ideally, this life-saving surgery should be performed at the time of the dog’s spay or neuter – or as soon as possible after that. Of course, it’s never too late to prophylactically pexy a dog… until they have an episode of GDV.

Please beware, the next picture of a gastropexy can seem graphic to some readers.

I have helped a number of pet owners perform gastropexies over the years. Some were wise to do it before GDV happens in their at-risk dog. Some learned the hard way (i.e. their dog got a twisted stomach, and that’s how they learned about the pexy option).

Either way, it can be done as a “stand alone” surgery, or at the time of a spay or neuter.

To recap, we know a lot about the risk factors of GDV. Be aware of them, and prevent those you can control. You could very well save your dog’s life.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Your pet is vomiting. Should you wait to go to the vet?

Your pet is limping. Should you wait to seek help?

Your pet has a mass. Should you wait to have it looked at?

These are common dilemmas, and the answer is… it depends!

Let’s keep our 3 examples.

. Many pets vomit every once in a while, and they are perfectly healthy otherwise.

Other times, repeated vomiting is a sign that something is brewing inside. And it could be anything: stomach problems, intestinal conditions, kidney disease, cancer etc.

. Some pets limp because of a sprain and get over it by the next day, just like a human.

Other times, ongoing limping is a sign of a problem: elbow arthritis, hip dysplasia or the most common cause of limping: a torn ACL.

. Many pets have skin masses. Most masses can only do one thing: get bigger. Very rarely does a mass get smaller. It would defy science: as cells divide, which they are genetically programmed to do, the mass gets bigger. It can be slow or it can be fast, but they usually get bigger over time. The only way to objectively know what is going on is to measure it.

So what’s a pet lover to do?

Should you keep an eye on it?

For a short while, possibly.

Waiting any longer is rarely a good idea.

. Repeated vomiting can lead to dehydration and electrolytes imbalances.

. An untreated joint problem invariably leads to arthritis, which can only get worse over time.

. A small mass is easier, less invasive and cheaper to remove than a large mass. This translates to longer anesthesia, higher surgery fees and higher chances of complications.

Occasionally, you will be a bit early and it’s a false alarm.

Most times, you will be right and acting early will save you time, money and frustration while avoiding pain for your pet.

At the very least, call your vet to ask questions. Many vets now offer telemedicine consultations, which means you don’t even have to take your pet to the vet. You can get advice from the comfort of your home.

Just keep in mind that vomiting may require X-rays or an ultrasound, limping may require X-rays and a mass may require lab testing.

Either way, don’t procrastinate, it rarely leads to good results.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

This is Kasper, a cute 3 year old Frenchie (French Bulldog)

He had a classic case of “brachycephalic syndrome” (because of his smooshed nose) (yes it’s a technical word), that caused snoring and difficulty breathing.

Brachycephalic syndrome usually has 4 parts:

. A tiny windpipe, which we can’t do anything about.

. An elongated soft palate, which means that the back of the roof of the mouth is so long that it covers the opening of the windpipe. When it vibrates, it causes snoring. Surgery involves shortening it.

. Saccules are fleshy structures at the opening of the airway. When brachycephalic breeds have difficulty breathing, over time, the saccules are mechanically pulled out into the airway – and further block the flow of oxygen. Surgery requires removing them.

. Stenotic nares, aka tiny nostrils, also prevents getting enough oxygen. Surgery involved making them wider, aka “a nose job” or a rhinoplasty.

Kasper had all 4 conditions, and had all 3 procedures, including the nose job.

PLEASE BE AWARE, THE PICTURES ARE NOT FOR THE FAINT OF HEART.

Here are side-by-side pictures of this nostrils, before and after surgery.

The very next day, Kasper’s owner writes: “Kasper has been amazing and very happy. His breathing is soooooo good!!! No snoring at all. Maybe some light breathing noise but no snoring.

Also no wheezing or reverse sneezes anymore at all. He hasn’t regurgitated food or water at all since surgery. He is eating well. No discomfort at all.

Now we both sleep through the night. I no longer jump out of bed like a ninja to check on him after being woken up by horrible sounds of reverse sneezing and seeing him struggle to take a breath. That in itself has been wonderful for us both!!

He also does not need to prop his head a certain way to breathe when he sleeps. I always kept pillows and stuffed animals in his crate to help him elevate himself to open airways. Haven’t needed those at all since surgery!

I am a very grateful momma!!

Huge success, we are very thankful for the new improved life you have given to Kasper! He can run like the wind now without getting winded.”

After 3 weeks of healing, Kasper had fully recovered and was able to have fun and enjoy a lot more oxygen.

In the right hands, this is typically a very rewarding surgery, with very good outcomes.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Removing skin masses is one of my most common surgeries.

Some skin masses are small. Some are in difficult locations, making the surgery tricky. Some are gigantic. Many were claimed to be “impossible to remove” – yet we still removed them. Some were supposed to be cancerous – and were benign. Some were supposed to be benign – and were cancerous. Yet others were indeed impossible to remove and required leg amputation.

What’s a pet lover to do? What is the right thing to do?

The problem with small skin masses is that they can be very misleading. I have come across multiple tiny masses, sometimes the size of a grain of rice, that were aggressive cancers.

Here is an example of a 1/3 inch mass, barely visible, hard to feel, under a cat’s fur. By some miracle, his owner found the mass and wisely decided to have it removed.

The biopsy revealed a fibrosarcoma, which is a notoriously aggressive cancer in cats.

Here are the 4 things you should never say or hear about lumps:

. “Just watch it.”

. “Keep an eye on it.”

. “It’s just a cyst.”

. “It’s just a fatty tumor.”

“Just watching” a mass grow bigger and bigger, or “keeping an eye” on a mass that keeps getting larger and larger, is exactly how we end up with masses the size of pumpkins.

By then, surgery is much more invasive, anesthesia is much longer, and the fees are much higher.

The “cyst” myth is just as unfortunate. A cyst is an actual diagnosis. It’s typically a benign mass that is usually filled with fluid. There are different types of cysts: follicular or epidermoid cysts, sebaceous cysts, dermoid cysts etc.

But the vast majority of so-called “cysts” I remove are not cysts. It was an assumption by the pet owner. “Cyst” is often used instead of “mass” or “tumor,” and it’s misleading at best.

“It’s just a fatty tumor” is something else I hear all the time. If someone tells you that, you should have a reasonable degree of doubt. NOBODY can assure you with 100% certainty that they know the diagnosis of a mass with further testing.

Why? Because I have never met anybody with microscopic vision.

You can only say what a mass is after testing it.

Case in point: a mast cell tumor is a very common skin tumor. It is nicknamed “the great imitator” because it can feel like anything – including a benign fatty tumor. As you can imagine, mistaking a benign tumor for a cancerous one can lead to really frustrating situations.

2 tests for skin masses: There are 2 ways to test a mass. 1. A needle test: During a needle test or Fine Needle Aspirate (or FNA), a needle is placed in the mass. Some cells are taken out and placed on a glass slide. It is then read under the microscope. It can either be read “in house,” meaning by your vet, or ideally it is sent out to a pathologist, who reads the cytology (ie the study of cells). My personal impression is that although cytology is cheaper and faster (a few days), it can provide misleading results. 2. A biopsy: A biopsy is a way to take a sample of the mass, ie some actual tissue, and not just cells. Being able to study the cells’ architecture, organization and relationship provides completely different information and a much safer diagnosis. The biopsy is always sent to a pathologist, who reads the histo-pathology (ie the study of abnormal tissue). My personal impression is that although a biopsy cytology is more expensive and take longer to read (7-10 days), it provides the most reliable results.

So what’s a loving pet owner to do?

At a minimum, skin masses should get tested via a needle test. Occasionally, they should be biopsied before surgery. Ideally, they should be removed and biopsied. Admittedly, it can get expensive since some dogs seem to be covered in masses, sometimes benign fatty masses. That’s where pet insurance is so helpful.

Here is an example of a giant mass in a Lab, whose owner was told to “just watch it” because it was tested as a benign fatty tumor.

So why bother if a mass is benign?

Benign doesn’t mean you should ignore it.

I have removed benign masses that were the size of a tennis ball, or a grapefruit, that prevented the patient from walking normally. I have removed benign masses that required leg amputation. And I have removed benign masses that were the size of a pumpkin that caused pain (by stretching the skin) and made the patients lose their balance.

If you find yourself in a situation where your vet seems to be brushing something off that genuinely concerns you, you have the right to seek a second opinion and I would encourage you to do so.

Bottom line: waiting is rarely a wise option.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified