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Breathless in SeattleKristin Kirkby Shaw, DVM, PhD
Diplomate ACVS & ACVSMR
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
October 11, 2015
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• Brachycephalic anatomy—what makes them so cute!
• Components of BAGS—more than you may have been taught.
• History and examination—and what the owners think.
• Surgical intervention—when is the best time?
• Medical management—beyond the airway.
• Prognosis—the sad truth?
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
Brachycephalic Airway Syndrome
and Gastrointes@nal
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Rise of the Frenchie: A Global Welfare Issue?
• French BD Breed Ranking USA: • 2005-‐ #38 • 2014-‐ # 9
• UK: • 2005-‐ #76 • 2014-‐#4
• Severity of respiratory signs are worsening due to selecTve breeding
• 60% of owners do not recognize signs of significant BAS
Liu, N, et al. Plos One 2015; www.akc.org
How does severe brachycephaly affect dog’s lives? Results of a structured preoperaTve owner quesTonnaire Frauke S. Roedler, Sabine Pohl, Gerhard U. Oechtering
• 100 quesTonnaires (61 pugs, 39 FB) • Mean age: 3.3 y (8 mo-‐11 y) • First clinical signs at ~1 year (3 mo-‐4 y) • 82% said clinical signs became more severe over Tme
• Loud breathing • 100% when exercising • 91% while sleeping • 66% at rest
• Choking fits: 70% • 40% at least once a week
• Collapsed at least once: 36% • CyanoTc • 20% >once a year • 7% > once a week
• Reverse sneeze: 73%
How does BAGS affect your dog?
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What is the most restricTve problem for your dog?
Exercise Intolerance
How long can you go for a walk with your dog?
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How much Tme does your dog need to recover?
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Summer is not a bulldog’s friend
Temperature > 66o F led to worsening of respiratory signs
46% of dogs have problems eaTng at least once a day:
FB more frequent than Pugs
• Nasal • StenoTc nares, aberrant conchal growth, deviated septum
• Pharyngeal • Excessive nasopharyngeal turbinates, elongated &
thickened som palate, everted tonsils, redundant pharyngeal Tssue, macroglossia
• Glonc • Everted laryngeal saccules, laryngeal edema, laryngeal
collapse • Tracheobronchial • HypoplasTc trachea, bronchial collapse
• GastrointesTnal
Components of BAGS
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The consequences of no nose
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
• Stenotic nares ! overgrown conchae !E/TSP ! everted tonsils and everted saccules ! laryngeal edema !laryngeal collapse
The domino effect: Part 1
Intranasal mucosal contact points
Schuenemann R JAAHA 2014
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Septal deviations in most Pugs
Schuenemann R JAAHA 2014
Conchae
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
• Nasal mucosa • Olfaction • Thermoregulation—evaporative cooling
• Airflow past the conchae is a negative feedback
for growth (this means the nares must be open) • Aberrant conchae present in 100% of
brachycephalics and often cause obstruction (Oechtering et al. 2007)
• Snoring, stertor • "Cough" • Reverse sneeze • Stridor • Dyspnea • Tachypnea • Heat & exercise intolerance • Cyanosis/ Syncope • PROGRESSIVE!
Respiratory Signs
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• 97% had esophageal, gastric or duodenal abnormali@es • Some of these dogs didn’t have clinical signs of GI disease • Severity of respiratory signs influences severity of GI, and
vice versa
The domino effect: Part 2
• Hiatal hernia ! gastroesophogeal reflux ! regurgitation ! esophagitis, laryngitits
• Gagging • “Coughing” • Retching • RegurgitaTon • VomiTng • Dilated stomach • Flatulence
Gastrointestinal Clinical Signs
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• No aspiraTon pneumonia, mortality 3.3% • Good-‐excellent improvement • 88% of respiratory disorders • 91% of GI disorders
• “Compared to other studies, decreased complica@ons and improved prognosis with combined GI management”
GI Medical Management
• Omeprazole 0.7 mg/kg q 24 h • 1 week at a Tme • For life
• FamoTdine 1 mg/kg q 12-‐24 h • Cisapride 0.2 mg/kg q 8 h • +/-‐ Sucralfate q 12 h • +/-‐ Prednisone 0.5 mg/kg q 12 h
Poncet CM et al. JSAP 2006
Brachycephalic airway obstructive syndrome in dogs: 90 cases
(1991-2008) Fasanella FJ, et al. JAVMA 2010
• English BD 61%, Pugs 21%, Boston Terriers 9% • ESP 94%, stenoTc nares 77%, everted laryngeal saccules 66%, everted tonsils 56% • Most dogs had 3 or 4 components
• Dogs with SN more likely to have ELS • Dogs with ELS more likely to have ET • Post op complicaTons 12%
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Surgical correction of brachycephalic syndrome in dogs: 62 cases
(1991-2004) Riecks TW, et al. JAVMA 2007
• English BD, Pug, Boston Terrier • English BD most likely to have hypoplasTc trachea • No dogs had everted saccules alone • 94% good-‐excellent outcome • Mortality 3.2% • “Favorable long-‐term outcome, regardless of age, breed, number/ combinaTon of diagnoses”
BAGS: Surgical approach
• Alaplasty and ESP early in life; some dogs need addiTonal surgery later in life
• Excise laryngeal saccules and everted tonsils • Laser-‐assisted turbinectomy? • Remember surgery is only part of the answer
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
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End Stage
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
• Laryngeal collapse • Tie-‐back • Permanent tracheostomy
• Heat stroke • AspiraTon pneumonia
Clients need to be educated on the realiTes of owning a bulldog
Stop Playing Here!
No reserves lem!
Use tongue to gauge quitting time
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• Correct stenoTc nares and ESP EARLY! (~4 months of age)
• May need addiTonal surgery later in life • Weight management • Avoid excess panTng (remember the domino) • Do not walk/ exercise when >66oF • Use a harness
• Light sedaTon and anT-‐inflammatories PRN • Treat GI component
Take Home Recommendations
Copyright © 2015 Animal Surgical Clinic of Sea:le. All rights reserved.
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Questions?
