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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

Thank You Sponsors!

•  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?


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



• 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


• 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


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End Stage


•  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


THANK YOU!

Questions?

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